My Career Story Universal: a life designing counseling for people with disabilities during COVID-19
Santilli S; Savickas S; Hartung P; Ginevra MC; Di Maggio I; Nota L; Soresi S
Journal Of Applied Research In Intellectual Disabilities
2021
2021-07
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journalArticle
<a href="http://doi.org/" target="_blank" rel="noreferrer noopener"></a>
Feasibility and Acceptability of a Reiki Intervention With Very Young Children Receiving Palliative Care.
BACKGROUND: Very little research has been reported examining nonpharmacologic symptom management strategies for very young, hospitalized children receiving palliative care, and none has involved Reiki-a light touch therapy. OBJECTIVES: To determine if completing a Reiki intervention with hospitalized 1- to 5-year-old children with chronic, life-limiting conditions receiving palliative care was feasible and acceptable. METHODS: Children ages 1 to 5 years receiving palliative care who were expected to be hospitalized for at least 3 weeks were recruited for a single-arm, mixed-methods, quasi-experimental pre/poststudy. Six protocolized Reiki sessions were conducted over 3 weeks. We calculated feasibility by the percentage of families enrolled in the study and acceptability by the percentage of families who completed all measures and 5 out of 6 Reiki sessions. Measures were collected at baseline, the end of the intervention period, and three weeks later. At the final follow-up visit, parents were verbally asked questions relating to the acceptability of the intervention in a short structured interview. RESULTS: We screened 90 families, approached 31 families, and recruited 16 families while 15 families declined. Reasons for not participating included that the child had "a lot going on," would be discharged soon, and families were overwhelmed. Of those enrolled, most completed all measures at three time points and 5 out of 6 Reiki sessions. We completed nearly all scheduled Reiki sessions for families that finished the study. All parents reported that they would continue the Reiki if they could, and almost all said they would participate in the study again; only one parent was unsure. DISCUSSION: Young children and their parents found Reiki acceptable; these results are comparable to an earlier study of children 7-16 years receiving palliative care at home and a study of massage for symptom management for hospitalized children with cancer. These findings add to the literature and support further investigation of Reiki's efficacy as a nonpharmacologic symptom management intervention.
Thrane SE; Grossoehme DH; Tan A; Shaner V; Friebert S
Nursing Research
2021
2021-07-12
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journalArticle
<a href="http://doi.org/10.1097/NNR.0000000000000540" target="_blank" rel="noreferrer noopener">10.1097/NNR.0000000000000540</a>
End of Life Outside of "Business Hours": A Retrospective Review Evaluating Time of Death and Provider Time at End of Life.
palliative care; pediatric; physician; compassion fatigue; advance practice nurse; OF-LIFE; PEDIATRIC PALLIATIVE CARE
Introduction: Pediatric palliative care (PPC) benefits patients and families, while potentially creating emotional and resource-management burdens for providers. This study's purpose was to characterize the occurrence of deaths attended by PPC providers outside of "business hours." Methods: N = 786 PPC patients at a single center died between 2008 and 2015. Descriptive statistics were prepared for all variables (Wilcoxon rank-sum test for continuous; chi-square or Fisher's exact test for categorical). Results: N = 434 (55%) of deaths occurred outside of business hours; n = 332 (70%) were attended by PPC. Time spent attending a death was not significantly longer when other PPC providers were present but was when certain tasks were performed (coordination with medical examiner and memory making). Conclusion: The occurrence of the majority of deaths outside of business hours has significant implications for service delivery models, provider emotional health, and health care value.
Hardy-Gomez M; Grossoehme DH; Strasshofer D; Brown M; Friebert S
Journal Of Palliative Medicine
2021
2021-07-01
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journalArticle
<a href="http://doi.org/10.1089/jpm.2021.0127" target="_blank" rel="noreferrer noopener">10.1089/jpm.2021.0127</a>
Attending to Clients' Psychological Needs During Career Construction Counseling
career construction counseling; career counseling process; counseling tasks; needs; problem formulation
Attending to clients' psychological needs during career counseling merits more attention in career theory and practice. We describe how the elaboration of clients' needs during career construction counseling supports clients' problem formulation. After reviewing the literature on the psychology of needs, we present and illustrate an intervention strategy with a case example. Counseling vignettes from the initial counseling task of problem formulation illustrate how to facilitate clients' narrative symbolization of their emotional experiences and associated needs. We explain how this strategy contributes to deepening clients' understanding of their problems and facilitates both the rewriting of a career narrative and the construction of new career plans. Analysis of the possibilities and limits of this practice merits attention in career counseling process research.
Sampaio C; Cardoso P; Rossier J; Savickas ML
Career Development Quarterly
2021
2021-06
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journalArticle
<a href="http://doi.org/10.1002/cdq.12252" target="_blank" rel="noreferrer noopener">10.1002/cdq.12252</a>
Screening electrocardiogram in young athletes and military members: a systematic review and meta-analysis.
sudden cardiac death; athlete; military; sudden cardiac arrest; electrocardiogram screening
OBJECTIVE: To determine the effect of electrocardiogram (ECG) screening on prevention of sudden cardiac arrest and death (SCA/D) in young athletes and military members. DATA SOURCES: MEDLINE, Embase, Cochrane CENTRAL, Web of Science, BIOSIS, Scopus, SPORT discus, PEDro, and clinicaltrials.gov were searched from inception to dates between 2/21/19 and 7/29/19. STUDY SELECTION: Randomized and non-randomized controlled trials, where pre-participation examination including ECG was the primary intervention used to screen athletes or military 40 years of age or younger. Accepted controls were no screening, usual care, or pre-participation examination without ECG. 3 published studies , and one conference abstract were identified for inclusion. DATA EXTRACTION: In all four studies, risk of bias was assessed with the Cochrane risk of bias tool, and found to be generally high. Two studies had data extracted for random effects meta-analysis, and the remaining study and conference abstract were included in narrative review. Overall quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Data Synthesis: Four non-randomized studies (11,689,172 participants) were included, all at high risk of bias. Pooled data from two studies (n= 3,869,274; very low quality evidence) observed an inconclusive 42% relative decrease in risk of sudden cardiac death (RR 0.58; 95% CI 0.23, 1.45), equating to an absolute risk reduction of .0016% The findings were consistent with a potential 67% relative decrease to a 45% relative increased risk in participants screened with ECG. Heterogeneity was found to be high as measured with I2 statistic (71%). Data from the remaining study and abstract were similarly inconclusive. CONCLUSION: Existing evidence for the effect of ECG screening is inconclusive and of very low quality. Our meta-analysis observed that screening ECG may result in considerable benefit or harm to participants. Higher quality studies are needed to reduce this uncertainty. PROSPERO Registration: CRD42019125560.
Lear A; Patel N; Mullen C; Simonson M; Leone V; Koshiaris C; Nunan D
Journal Of Athletic Training
2021
2021-05-26
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journalArticle
<a href="http://doi.org/10.4085/1062-6050-0746.20" target="_blank" rel="noreferrer noopener">10.4085/1062-6050-0746.20</a>
Incidence of sudden cardiac arrest and death in young athletes and military members: a systematic review and meta-analysis.
incidence; sudden cardiac death; military; athletes; sudden cardiac arrest
OBJECTIVES: The goals of this review are to evaluate the quality of the evidence on the incidence of sudden cardiac arrest and death (SCA/D) in athletes and military members; and to estimate annual incidence of SCA/D. DATA SOURCES: MEDLINE, Embase, Cochrane CENTRAL, Web of Science, BIOSIS, Scopus, SPORT discus, PEDro, and clinicaltrials.gov were searched from inception to dates between 2/21/19-7/29/19. STUDY SELECTION: Studies which reported incidence of SCA/D or both in athletes, or military members under age 40 were eligible for inclusion. 40 studies were identified for inclusion Data Extraction: Risk of bias was assessed using a validated, customized tool for prevalence studies in all included studies. 12 were found to be low ROB, with the remaining 28 moderate or high ROB. Data was extracted for narrative review, and meta-analysis. DATA SYNTHESIS: Random-effects meta-analysis was performed in studies judged to be low risk of bias in two separate categories: 5 studies on regional or national level data including athletes at all levels, and both sexes included 130 events of SCD, with a total of 11,272,560 athlete years showing a cumulative incidence rate of 0.98 [95%CI: 0.62, 1.53] per 100,000 athlete years, with high heterogeneity with I2 of 78%; 3 Studies on competitive athletes aged 14 to 25 were combined, and included 183 events, and 17,798758 athlete years showing an incidence rate of 1.91[95%CI: 0.71; 5.14] per 100,000 athlete years with high heterogeneity with I2 of 97%. The remaining low risk of bias studies were in military members, and were not synthesized. CONCLUSION: The worldwide incidence of SCD is a rare event. Low risk of bias studies indicate incidence to be below 2 per 100,000 athlete years. Overall, the quality of the evidence available is low, but there are high quality individual studies to inform the question of incidence levels. PROSPERO Registration: CRD42019125560.
Lear A; Patel N; Mullen C; Simonson M; Leone V; Koshiaris C; Nunan D
Journal Of Athletic Training
2021
2021-05-26
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journalArticle
<a href="http://doi.org/10.4085/1062-6050-0748.20" target="_blank" rel="noreferrer noopener">10.4085/1062-6050-0748.20</a>
Reflective Writing about Near-Peer Blogs: A Novel Method for Introducing the Medical Humanities in Premedical Education.
Blogs; Narrative medicine; Near-peer learning; Premedical education; Reflective writing
Narrative analysis, creative writing, and interactive reflective writing have been identified as valuable for professional identity formation and resilience among medical and premedical students alike. This study proposes that medical student blogs are novel pedagogical tools for fostering peer-to-peer learning in academic medicine and are currently underutilized as a near-peer resource for premedical students to learn about the medical profession. To evaluate the pedagogical utility of medical student blogs for introducing core themes in the medical humanities, the authors conducted qualitative analysis of one hundred seventy-six reflective essays by baccalaureate premedical students written in response to medical student-authored narrative blog posts. Using an iterative thematic approach, the authors identified common patterns in the reflective essays, distilled major themes, coded the essays, and conducted narrative analysis through close reading. Qualitative analysis identified three core themes (empathic conflict, bias in healthcare, and the humanity of medicine) and one overarching theme (near-peer affinities). The premedical students’ essays demonstrated significant self-reflection in response to near-peer works, discussed their perceptions of medical professionalism, and expressed concerns about their future progress through the medical education system. The essays consistently attributed the impact of the medical student narratives to the authors’ status as near-peers. The authors conclude that reading and engaging in reflective writing about near-peer blog posts encourages premedical students to develop an understanding of core concepts in the medical humanities and promotes their reflection on the profession of medicine. Thus, incorporating online blogs written by medical trainees as narrative works in medical humanities classrooms is a novel pedagogical method for fostering peer-to-peer learning in academic medicine. [ABSTRACT FROM AUTHOR]
Bracken RC; Major A; Paul A; Ostherr K
Journal Of Medical Humanities
2021
2021-04-19
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journalArticle
<a href="http://doi.org/" target="_blank" rel="noreferrer noopener"></a>
A Survey Analysis of TeleHealth Access to Geriatric Patients During COVID-19
Mistry S; Singh S; Mistry M; Jinka S; Gupta A; Belen M
Journal Of The American Geriatrics Society
2021
2021-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/" target="_blank" rel="noreferrer noopener"></a>
The Role of Gender and Couple Status in Predicting Advance Care Planning Practices
Harlan L; Labatte A; Baughman KR; Ludwick R
Journal Of The American Geriatrics Society
2021
2021-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/" target="_blank" rel="noreferrer noopener"></a>
Using Telehealth to Mentor Community-Based Interprofessional Care
Drost J; Fosnight S; Nauer T; Chrzanowski B; Smith L; Hazelett S; Sanders M; Kropp D
Journal Of The American Geriatrics Society
2021
2021-04
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journalArticle
<a href="http://doi.org/" target="_blank" rel="noreferrer noopener"></a>
Evaluation of a Virtual Simulation for Geriatric Team-Based Care
Brown DK; Sanders M; Drost J; Hazelett S; Fosnight S; Kropp D; Patton R; Kidd L
Journal Of The American Geriatrics Society
2021
2021-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/" target="_blank" rel="noreferrer noopener"></a>
Review of international clinical guidelines related to prenatal screening during monochorionic pregnancies.
AMNIOTIC liquid; clinical guidelines; FETAL growth retardation; monochorionic twin pregnancy; PREGNANCY; PRENATAL care; screening; UMBILICAL arteries
We conducted a search for international clinical guidelines related to prenatal screening during monochorionic pregnancies. We found 25 resources from 13 countries/regions and extracted information related to general screening as well as screening related to specific monochorionic complications, including twin-twin transfusion syndrome (TTTS), selective fetal growth restriction (SFGR), and twin anemia-polycythemia sequence (TAPS). Findings reveal universal recommendation for the early establishment of chorionicity. Near-universal recommendation was found for bi-weekly ultrasounds beginning around gestational week 16; routine TTTS and SFGR surveillance comprised of regularly assessing fetal growth, amniotic fluids, and bladder visibility; and fetal anatomical scanning between gestational weeks 18-22. Conflicting recommendation was found for nuchal translucency screening; second-trimester scanning for cervical length; routine TAPS screening; and routine umbilical artery, umbilical vein, and ductus venosus assessment. We conclude that across international agencies and organizations, clinical guidelines related to monochorionic prenatal screening vary considerably. This discord raises concerns related to equitable access to evidence-based monochorionic prenatal care; the ability to create reliable international datasets to help improve the quality of monochorionic research; and the promotion of patient safety and best monochorionic outcomes. Patients globally may benefit from the coming together of international bodies to develop inclusive universal monochorionic prenatal screening standards.
Nicholas L; Fischbein R; Ernst-Milner S; Wani R
Journal Of Clinical Medicine
2021
2021-03-08
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journalArticle
<a href="http://doi.org/10.3390/jcm10051128" target="_blank" rel="noreferrer noopener">10.3390/jcm10051128</a>
Journal of Vocational Behavior's 50th anniversary: Looking back and going forward
Highlights •Describes goals for JVB's role and function•Reports experiences and challenges during editorial term•Emphasizes purview of JVB as vocational behavior of individuals•Considers the growth of vocational psychology•Muses about the future of JVB
Savickas ML
Journal Of Vocational Behavior
2021
2021-03-01
journalArticle
<a href="http://doi.org/" target="_blank" rel="noreferrer noopener"></a>
Health Equity, Cuban Style.
UNITED States; HEALTH services accessibility; CUBA; HEALTH promotion; MEDICAL policy; HEALTH disparities; INTEGRATED health care delivery; MEDICAL care costs; HEALTH care industry
The United States has not yet decided to ensure that every citizen has access to health care services at reasonable cost. The United States spends more on health care than any other country by far. Yet the health status of the US population, when compared with that of like nations, remains poor. The US system does not operate efficiently, fares poorly in terms of health equity, and has an illness and injury care industry with many uncoordinated "systems" focused on treating individuals rather than on improving health status. There are lessons for us in Cuba's health system. [ABSTRACT FROM AUTHOR]
Keck CW
Ama Journal Of Ethics
2021
2021-03
journalArticle
<a href="https://journalofethics.ama-assn.org/article/health-equity-cuban-style/2021-03" target="_blank" rel="noreferrer noopener">https://journalofethics.ama-assn.org/article/health-equity-cuban-style/2021-03</a><a href="http://doi.org/" target="_blank" rel="noreferrer noopener"></a>
Influenza and Embodied Sociality in Early Twentieth-Century American Literature
influenza; embodied sociality; american literature
This article reads two early twentieth-century American novels, William Maxwell’s They Came Like Swallows (1937) and Katherine Anne Porter’s Pale Horse, Pale Rider (1939), in relation to the Spanish flu pandemic of 1918–19 and the history of public health. Beyond serving as a literary record of “America’s forgotten pandemic,” it interprets these novels as experiments in what I term “embodied sociality”: a biocultural model of social life encompassing both the abstract, symbolic dimensions of community belonging and the concrete, biological contours of collective living made visible through the spread of infectious disease. I argue that Swallows and Pale Horse challenge the logic of “modern health citizenship,” which prioritized personal hygiene measures to prevent the spread of influenza through a community, that was promoted in turn-of-the-century public health efforts. Instead, these novels destabilize perceptions of the body as a discrete and potentially impermeable entity, revealing how to belong to a community is to be susceptible to the unseen agents of disease that move between bodies in close proximity, as well as to be, albeit unwittingly, a potential carrier of disease. Attending to embodied sociality as made visible by the flu, these novels necessitate a new way of writing pandemic—one that blends the narrative conventions of plague writing and autopathography. In so doing, I contend, Pale Horse and Swallows invite us to reimagine embodiment and community belonging by holding the local and global, personal and political, individual and collective dimensions of pandemic together. "When we recognize pandemic as simultaneously individual and communal, the boundaries that differentiate proximal bodies from one another and from a collective social body blur. And this knowledge, in turn, transforms the way we write pandemic."
Bracken Rachel Conrad
American Literary History
2020
1905-07
journalArticle
<a href="http://doi.org/10.1093/alh/ajaa017" target="_blank" rel="noreferrer noopener">10.1093/alh/ajaa017</a>
Improving Patient Experience by Teaching Empathic Touch and Eye Gaze: A Randomized Controlled Trial of Medical Students
empathy; patient perception; empathic touch; eye gaze; standardized patient encounter
Background: Empathy is critical for optimal patient experience with health-care providers. Verbal empathy is routinely taught to medical students, but nonverbal empathy, including touch, less so. Our objective was to determine whether instruction encouraging empathic touch and eye gaze at exit can impact behaviors and change patient-perceived empathy. Materials: A randomized, controlled, double-blinded trial of 34 first-year medical students was conducted during standardized patient (SP) interviews. A video either encouraging empathic touch and eye gaze at exit or demonstrating proper hand hygiene (control) was shown. Encounter videos were analyzed for touch and eye gaze at exit. The Jefferson Scale of Patient Perceptions of Physician Empathy was used to measure correlations. Intervention students were surveyed regarding patient touch. Results: Of this, 23.5% of intervention students touched the SP versus zero controls; 88.2% of intervention students demonstrated eye gaze at exit. Eye gaze at exit positively impacted patient-perceived empathy (correlation = 0.48, P > .001). Survey responses revealed specific barriers to touch. Conclusion: Medical students may increase perceived empathy using eye gaze at exit. Instruction on empathic touch and sustained eye gaze at exit at the medical school level may be useful in promoting empathic nonverbal communication. Medical educators should consider providing specific instructions on how to appropriately touch patients during history-taking. This is one of the few studies to explore touch with patients and the first ever to report the positive correlation of a health provider's sustained eye gaze at exit with the patient's perceived empathy. Further studies are needed to explore barriers to empathic touch.
Lecat P;Dhawan N;Hartung PJ;Gerzina H;Larson R;Konen-Butler C
Journal Of Patient Experience
2020
2020-12
journalArticle
<a href="http://doi.org/10.1177/2374373520916323" target="_blank" rel="noreferrer noopener">10.1177/2374373520916323</a>
Practical Recommendations for Timely, Accurate Diagnosis of Symptomatic Alzheimer's Disease (MCI and Dementia) in Primary Care: A Review and Synthesis.
Alzheimer Disease; Biomarkers; Dementia; Disease-Modifying Therapies; Mild Cognitive Impairment; Primary Health Care
The critical role of primary care clinicians (PCCs) in Alzheimer's disease (AD) prevention, diagnosis and management must evolve as new treatment paradigms and disease-modifying therapies (DMTs) emerge. Our understanding of AD has grown substantially: No longer conceptualized as a late-in-life syndrome of cognitive and functional impairments, we now recognize that AD pathology builds silently for decades before cognitive impairment is detectable. Clinically, AD first manifests subtly as mild cognitive impairment (MCI) due to AD before progressing to dementia. Emerging optimism for improved outcomes in AD stem from a focus on preventive interventions in mid-life and timely, biomarker-confirmed diagnosis at early signs of cognitive deficits (ie, MCI due to AD and mild AD dementia). A timely AD diagnosis is particularly important for optimizing patient care and enabling the appropriate use of anticipated DMTs. An accelerating challenge for PCCs and AD specialists will be to respond to innovations in diagnostics and therapy for AD in a system that is not currently well positioned to do so. To overcome these challenges, PCCs and AD specialists must collaborate closely to navigate and optimize dynamically evolving AD care in the face of new opportunities. In the spirit of this collaboration, we summarize here some prominent and influential models that inform our current understanding of AD. We also advocate for timely and accurate (ie, biomarker-defined) diagnosis of early AD. In doing so, we consider evolving issues related to prevention, detecting emerging cognitive impairment, and the role of biomarkers in the clinic.
Liss JL;Seleri MAS;Cummings J;Atri A;Geldmacher DS;Candela SF;Devanand DP;Fillit HM;Susman J;Mintzer J;Bittner T;Brunton SA;Kerwin DR;Clay JW;Small GW;Grossberg GT;Clevenger CK;Cotter V;Stefanacci R;Wise-Brown A;Sabbagh MN
Journal Of Internal Medicine
2021
2021-01-18
journalArticle
<a href="http://doi.org/10.1111/joim.13244" target="_blank" rel="noreferrer noopener">10.1111/joim.13244</a>
Using contact-based education to destigmatize opioid use disorder among medical students.
medical education; Opioids; opioid use disorder; osteopathic medicine
All first- and second-year (i.e., pre-clinical) medical students at a large, Midwestern medical school with three campuses were invited to participate in a two-arm, parallel educational study comparing the efficacy of two types of curricular interventions. Students at the main campus attended the modified contact-based education panel or the didactic lecture in person, while students at the two distance campuses attended the modified contact-based education or lecture remotely using the University's videoconferencing system. Impact: A total of 109 students participated in the study (average age 24.2 years (SD = 2.6), 64.2% female, 79.8% white, 56.0% second-year students, 67.9% attended on main campus, lecture = 52 participants, modified contact-based = 57 participants). Baseline responses were similar across groups. Following the session, participants in both interventions rated drug abuse (percent increase = 21.2%, p < .001) and prescription drug diversion (percent increase = 7.6%, p = .004) as more serious problems. Participants from both interventions expressed increased confidence in caring for patients with OUD (percent increase = 45.5%, p < .001) and increased interest in pursuing MAT training (percent increase = 21.5%, p = .04). Both curricular interventions were equally effective at reducing OUD stigma with a significant 8.2% decrease in total stigma scores and a large effect size (p < .001, η(p) (2) = .34). Lastly, participants with lower post-assessment OUD stigma scores were more likely to indicate that they would pursue additional training to provide MAT (p = .02). Lessons learned: Exposure to opioid-specific education with a focus on MAT and recovery, regardless of education type, positively affected opioid-related postgraduate intentions and reduced OUD stigma. Notably, these findings suggest that there are multiple efficacious techniques to reduce OUD stigma during preclinical training.
Mort Sophia C; Díaz SR; Beverly EA
Teaching And Learning In Medicine
2020
2020-11-16
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1080/10401334.2020.1820869" target="_blank" rel="noreferrer noopener">10.1080/10401334.2020.1820869</a>
Pandemic Productivity: Student-Run Free Clinic Integrates Behavioral Health in the Wake of COVID-19.
Fischbein R; Gardner-Buckshaw S; Loucek A; Ravichandran S; Eicher M; Boltri JM
Academic Psychiatry
2020
2020-11-17
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journalArticle
<a href="http://doi.org/10.1007/s40596-020-01368-w" target="_blank" rel="noreferrer noopener">10.1007/s40596-020-01368-w</a>
A method for evaluating breast cancer screening strategies using screen-preventable loss of life.
The objective of this study is to describe how screen-preventable loss of life (screen-PLL) can be used to analyze the distribution of life savings with mammographic screening. The determination of screen-PLL with mammography is possible using a natural history model of breast cancer that simulates clinical and pathologic events of this disease. This investigation uses a Monte Carlo Markov model with data from the Surveillance, Epidemiology, and End Results Program; American Cancer Society; and National Vital Statistics System. Populations of one million women per screening strategy are simulated over a lifetime with mammographic screening based on current guidelines of the American Cancer Society (ACS), United States Preventive Services Task Force (USPSTF), triennial screening from age 50-70, and no screening. Screen-PLL curves are generated and show guideline performance over a lifetime. The screen-PLL curve with no screening is determined by tumor discovery through clinical awareness and has the highest values of screen-PLL. The ACS and USPSTF strategies demonstrate screen-PLL curves favoring the elderly. The curve for triennial screening is more uniform than the ACS or USPSTF curves but could be improved by adding screen(s) at either end of the 50-70 age range. This study introduces the use of screen-PLL as a tool to improve the understanding of screening guidelines and allowing a more balanced allocation of life savings across an aging population. The method presented shows how screen-PLL can be used to analyze and potentially improve breast cancer screening guidelines.
Carter KJ; Castro F; Morcos RN
Plos One
2020
1905-07
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journalArticle
<a href="http://doi.org/10.1371/journal.pone.0243113" target="_blank" rel="noreferrer noopener">10.1371/journal.pone.0243113</a>
Prioritizing Age-Friendly Domains for Transforming a Mid-Sized American City.
questionnaire; survey; older people; age-friendliness; age-friendly; age-friendly cities; use of technology
In May 2019, the city of Akron in the state of Ohio was admitted into AARP's network of age friendly cities and communities. Akron has a long history of aging services initiative that date back to the 1970s. To provide direction for future aging initiatives, an assessment of Akron's current state was conducted in early 2020. A survey designed to capture information on the eight Age-friendly domains was designed and mailed to 3000 randomized individuals in Akron's ten political wards. A total of 656 individuals responded and returned the survey. Akron is rated good to excellent by older Akronites; people want to stay in their neighborhood and in their home. Most Akronites like and use their neighborhood parks, find their streets well-lit, and feel safe walking in their neighborhood. Most respondents rated transportation in Akron as good to very good, but they found sidewalks good to poor. There is a high level of access to social and educational activities and a substantial opportunity to include more people. About two-thirds of respondents participate in faith-based activities, volunteer, and participate in city-sponsored events. Loneliness is not or rarely a problem for three quarters of respondents. Around 56.5% of respondents indicated they disagree they are disconnected from the community. There is high level of access to the Internet and public WiFi in Akron and a substantial opportunity to include more people. Overall, Akron has benefitted from its historical efforts and has the opportunity to impact on more older adults as the older population grows.
Sterns AA; Sterns HL; Walter A
International Journal Of Environmental Research And Public Health
2020
2020-12-06
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journalArticle
<a href="http://doi.org/10.3390/ijerph17239103" target="_blank" rel="noreferrer noopener">10.3390/ijerph17239103</a>
Ethical challenges arising in the COVID-19 pandemic: An overview from the Association of Bioethics Program Directors (ABPD) task force
Public Health; decision-making; health care delivery; health policy; end-of-life issues; rationing/resource allocation
The COVID-19 pandemic has raised a host of ethical challenges, but key among these has been the possibility that health care systems might need to ration scarce critical care resources. Rationing policies for pandemics differ by institution, health system, and applicable law. Most seem to agree that a patient’s ability to benefit from treatment and to survive are first-order considerations. However, there is debate about what clinical measures should be used to make that determination and about other factors that might be ethically appropriate to consider. In this paper, we discuss resource allocation and several related ethical challenges to the healthcare system and society, including how to define benefit, how to handle informed consent, the special needs of pediatric patients, how to engage communities in these difficult decisions, and how to mitigate concerns of discrimination and the effects of structural inequities.
McGuire AL;Aulisio M P;Davis FD;Erwin C;Harter TD;Jagsi R;Klitzman R;Macauley R;Racine E;Wolf SM;Wynia M;Wolpe PR;The COVID-19 Task Force of the Association of Bioethics Program Directors (ABPD)
The American Journal of Bioethics
2020
2020-07-02
journalArticle
<a href="http://doi.org/10.1080/15265161.2020.1764138" target="_blank" rel="noreferrer noopener">10.1080/15265161.2020.1764138</a>
Rural and remote communities: Unique ethical issues in the COVID-19 pandemic
We expand on the article “Ethical Challenges Arising in the COVID-19 Pandemic: An Overview from the Association of Bioethics Program Directors (ABPD) Task Force” to consider the ways in which rural and remote communities pose unique ethical questions in the current COVID-19 pandemic.
Erwin C;Aultman J;Harter T;Illes J;Kogan RCJ
The American Journal of Bioethics
2020
2020-07-02
journalArticle
<a href="http://doi.org/10.1080/15265161.2020.1764139" target="_blank" rel="noreferrer noopener">10.1080/15265161.2020.1764139</a>
Ohio cardiovascular health collaborative (Cardi-OH) needs assessment results
Khoury S;Wright JT;Perzynski AT;Caron A;Rao G;Koroukian S;Solomon GD;Holliday MB;Gardner-Buckshaw SL;Dworken L;Beverly E;Wexler R;Nevar A;Nance M;Albanese S;Wharton DP;Applegate MS;Konstan M;Bolen S
Journal Of General Internal Medicine
2020
2020-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/" target="_blank" rel="noreferrer noopener"></a>
Diagnosing the American Girl: Henry James' "Daisy Miller" as a Study in Illness Narrative
Narrative Medicine; Illness Narrative; Daisy Miller; Henry James
Bracken, R.C.
The Intima: A Journal of Narrative Medicine
2019
Bracken, R.C.
journalArticle
Influenza and Embodied Sociality in Early Twentieth-Century American Literature
Pandemic; 1918 Influenza Pandemic; Spanish Flu; Public Health; Katherine Anne Porter
This article reads two early twentieth-century American novels, William Maxwell’s They Came Like Swallows (1937) and Katherine Anne Porter’s Pale Horse, Pale Rider (1939), in relation to the Spanish flu pandemic of 1918–19 and the history of public health. Beyond serving as a literary record of “America’s forgotten pandemic,” it interprets these novels as experiments in what I term “embodied sociality”: a biocultural model of social life encompassing both the abstract, symbolic dimensions of community belonging and the concrete, biological contours of collective living made visible through the spread of infectious disease. I argue that Swallows and Pale Horse challenge the logic of “modern health citizenship,” which prioritized personal hygiene measures to prevent the spread of influenza through a community, that was promoted in turn-of-the-century public health efforts. Instead, these novels destabilize perceptions of the body as a discrete and potentially impermeable entity, revealing how to belong to a community is to be susceptible to the unseen agents of disease that move between bodies in close proximity, as well as to be, albeit unwittingly, a potential carrier of disease. Attending to embodied sociality as made visible by the flu, these novels necessitate a new way of writing pandemic—one that blends the narrative conventions of plague writing and autopathography. In so doing, I contend, Pale Horse and Swallows invite us to reimagine embodiment and community belonging by holding the local and global, personal and political, individual and collective dimensions of pandemic together.
Bracken, RC
American Literary History
2020
Bracken RC
journalArticle
https://doi.org/10.1093/alh/ajaa017
Measurement invariance by age group for the aging men’s masculinity ideologies inventory:
To date, work on masculinity ideologies, or the culture-based standards and norms expected of boys and men, has focused almost exclusively on younger adulthood....
Edward HT; Webster BA; Stanley JT; Levant RF
The Journal of Men’s Studies
2020
2020-03-15
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1177/1060826520911159" target="_blank" rel="noreferrer noopener">10.1177/1060826520911159</a>
Public health preparedness and response competency model methodology.
Objective: The Pandemic and All-Hazards Preparedness Act calls for establishing a competency-based training program to train public health practitioners. To inform such training, the Centers for Disease Control and Prevention and the Association of Schools of Public Health managed groups of experts to produce a competency model which could function as a national standard of behaviorally based, observable skills for the public health workforce to prevent, protect against, respond to, and recover from all hazards.; Design: A systematic review of existing competency models generated a competency model of proposed domains and competencies.; Participants: National stakeholders were engaged to obtain consensus through a three-stage Delphi-like process.; Results: The Delphi-like process achieved 84 percent, 82 percent, and 79 percent response rates in its three stages. Three hundred sixty six unique individuals responded to the three-round process, with 45 percent (n = 166) responding to all three rounds. The resulting competency model features 18 competencies within four core learning domains targeted at midlevel public health workers.; Conclusions: Practitioners and academics have adopted the Public Health Preparedness and Response Core Competency Model, some of whom have formed workgroups to develop curricula based on the model. Efforts will be needed to develop evaluation materials for training and education programs to refine the model as well as for future training and education initiatives.
Ablah E; McGean WE; McElligott JE; Biesiadecki LA; Gotsch AR; Keck C W; Gebbie KM
American Journal of Disaster Medicine
2020
2020-09
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.5055/ajdm.2019.0338" target="_blank" rel="noreferrer noopener">10.5055/ajdm.2019.0338</a>
Does using humor to cope with stress justify making fun of patients?
This article considers 3 reasons for derogatory humor in clinical settings and argues that when such humor is directed at patients without understanding their complex histories, it can diminish the therapeutic relationship rather than serve as a coping strategy. This article also investigates how narrative medicine can guide deeper understanding of the motivations for using humor in clinical settings, why humor is directed at a particular person or group, and why derogatory, cynical, or dark humor might be unethical and unprofessional. Colleagues and mentors are essential for guiding students' and trainees' professional development and for helping them cultivate coping strategies that do not cause harm.
Aultman JM; Meyers E
American Medical Association Journal of Ethics
2020
2020-07-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1001/amajethics.2020.576" target="_blank" rel="noreferrer noopener">10.1001/amajethics.2020.576</a>
Efficacy of a group career construction intervention with urban youth of colour
validity; barriers; self-efficacy; adaptability; continuity; vocational identity; career construction theory; life-design; career adaptability; adapt-abilities scale; adolescent career development; career construction counselling; exploration behavior; Identity; supports
The efficacy of a three-week career construction counselling group intervention that was structured using the My Career Story workbook [Savickas, M. L., & Hartung, P. J. (2012). My career story: An autobiographical workbook for life-career success.] was examined using a pre/post-test design. The group intervention was delivered within an urban high school largely comprising African American, Puerto Rican and Dominican students across two semesters. Both groups completed two pre/post-test measures of vocational identity and a career adaptability measure. Results indicated that the career construction intervention increased scores on measures of vocational identity and control and con?dence dimensions of career adaptability. Implications for career intervention with adolescents of colour and for future research are discussed.
Cadaret MC; Hartung PJ
British Journal of Guidance & Counselling
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journalArticle
<a href="http://doi.org/10.1080/03069885.2020.1782347" target="_blank" rel="noreferrer noopener">10.1080/03069885.2020.1782347</a>
"Living life as if i never had cancer": A study of the meaning of living well in adolescents and young adults who have experienced cancer
childhood; definition; quality of life; advance care planning; cancer; adolescent; advance care
Background Cancer diagnoses pose challenges to adolescents' and young adults' (AYA) physical, mental, and emotional health, and developmental tasks. In order for AYAs, caregivers, clinicians, and other collaborators to optimize health outcomes (coproduction of health), understanding what living well means for AYAs who have experienced cancer is necessary. The objective was to develop an empirical definition of "living well" for AYAs who have experienced cancer to broadly understand AYA values and priorities. This definition may ultimately guide future conversations between caregivers and AYAs, eliciting thorough, personal definitions of living well from individual AYAs. Such conversations may enhance AYA participation in coproducing their health. Procedure Qualitative analysis using a phenomenological approach of N = 30 structuredRespecting Choicesinterviews conducted with AYAs (14-21 years; mean 84.2 [SD 69] months postcancer diagnosis with 21% on active treatment) from four tertiary pediatric hospitals in the context of a primary study of a pediatric advance care planning intervention trial. Results AYAs who have experienced cancer conceptualized "living well" as maintaining physical, mental, and emotional health, as well as engaging in purposeful, age-appropriate activities with people important to them. Living well had three components: living mindfully, living an identity as a healthy AYA, and spending time with friends and family. Conclusions Conversations with AYAs who have experienced cancer elicited rich, complex concepts of "living well." Provider initiation of discussions about living well may facilitate personalized goals of care conversations. This study may serve as the basis to design and prototype future clinical interventions to enhance AYA engagement.
Schreiner K; Grossoehme DH; Friebert S; Baker JN; Needle J; Lyon ME
Pediatric Blood & Cancer
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journalArticle
<a href="http://doi.org/10.1002/pbc.28599" target="_blank" rel="noreferrer noopener">10.1002/pbc.28599</a>
The segregated gun as an indicator of racism and representations in film
race; magical negro
Film emphasizes an ironic history of racism in gun control and ownership and a justification for seeking justice among the Black community, but film also perpetuates structural racism and bias, segregating Black from White, and failing to promote equality, solidarity, and progress. The gun is both a symbol of structural racism, and an expression through which critical attitudes and political statements can carry greater meaning and lead to positive action, empowerment, and desegregation. The symbolic meaning of guns in the hands of Blacks as violent, exceptional or some other stereotypical character trope is illustrated using three selected films including: Django Unchained, John Q., and Proud Mary. This paper is divided into three acts: Act I: The gun as symbol of structural racism in film; Act II: Stereotypical characters and their guns; Act III: Desegregation of the gun in film. These sections illustrate the meaning and representation of the gun as a theatrical object in film, and when in the hands of stereotypical character tropes, has perpetuated racist beliefs and attitudes that have not been adequately addressed in the film industry. To desegregate the gun in film, filmmakers need to critically examine the overt and hidden film texts and how the gun, and the characters wielding it, are perceived among audiences.
Aultman JM; Piatt E; Piatt J
Humanities & Social Sciences Communications
2020
2020-07-27
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journalArticle
<a href="http://doi.org/10.1057/s41599-020-0525-1" target="_blank" rel="noreferrer noopener">10.1057/s41599-020-0525-1</a>
The development and evaluation of a brief form of the normative male alexithymia scale (NMAS-BF).
Female; Humans; Male; Adult; Aged; Middle Aged; Reproducibility of Results; Psychometrics; Factor Analysis Statistical; Socialization; Affective Symptoms/diagnosis/psychology; Brief Psychiatric Rating Scale/standards
The current study extended prior work on the Normative Male Alexithymia Scale (NMAS), a unidimensional measure of some men's limitations in expressing emotion that results from gender-based socialization informed by the masculine norm of restrictive emotionality (RE). Data (N = 505 men) were from Amazon Mechanical Turk participants. First, dimensionality was reassessed using exploratory factor analysis, which supported the unidimensional structure. Second, based on these results, three 6-item models of the NMAS-Brief Form (NMAS-BF) were developed, based on classical test theory (CTT), CTT optimized to avoid item redundancy, and item response theory (IRT). Third, the relative fits of these versions were assessed using confirmatory factor analysis on a separate part of the sample, finding that the IRT version was the best fitting model. Fourth, evidence for reliability for the
Levant RF; Parent MC
Journal of counseling psychology
2019
2019-03
© 2018 Wiley Periodicals, Inc.
journalArticle
<a href="http://doi.org/10.1037/cou0000312" target="_blank" rel="noreferrer noopener">10.1037/cou0000312</a>
PMID: 30284847
Moderation and mediation of the relationships between masculinity ideology and health status.
Adolescent; Female; Humans; Male; Adult; Aged; Middle Aged; Young Adult; Surveys and Questionnaires; Health Status; Masculinity; Health Behavior/physiology
OBJECTIVE: The purpose of this study was to assess the direct and indirect relationships between the endorsement of traditional masculinity ideology (TMI) and self-reported health status through potential mediating variables of expectations of benefits from health risk behaviors and actual health risk behaviors. In addition, the objective was to test the moderating effect of gender identity, broadly defined (including cisgender and transgender men and women and nonbinary persons). METHOD: Participants (N = 1233; 34.3% transgender) participated in an online survey, responding to measures of TMI, expectations of benefits, health behaviors, health status, and demographics. Data were analyzed using conditional process modeling. RESULTS: TMI was positively and directly associated with general health status for self-identified men (regardless of their sex assigned at birth), and with mental health for both men and women, but was not associated with physical health for persons of any gender identity. TMI was positively and directly associated with expectations of benefits for both men and women. Expectations of benefits from engaging in health risk behaviors was positively associated with health risk behaviors, and health risk behaviors had a large negative association with health status, for people of all gender identities. CONCLUSIONS: TMI may be a general and mental health protective factor for self-identified men, and a mental health protective factor for women, regardless of assigned sex at birth. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Levant RF; Jadaszewski S; Alto K; Richmond K; Pardo S; Keo-Meier C; Gerdes Z
Health psychology : official journal of the Division of Health Psychology, American Psychological Association
2019
2019-02
Copyright © 2019 Elsevier Inc. All rights reserved.
journalArticle
<a href="http://doi.org/10.1037/hea0000709" target="_blank" rel="noreferrer noopener">10.1037/hea0000709</a>
PMID: 30652914
An appraisal of the american psychological association's clinical practice guideline for the treatment of posttraumatic stress disorder.
Humans; Adult; Comorbidity; United States; Attitude of Health Personnel; Practice Guidelines as Topic; Professional Autonomy; Psychotherapy/methods/standards; Societies Scientific; Evidence-Based Practice/methods/standards; Stress Disorders Post-Traumatic/diagnosis/psychology/therapy
In 2017, the American Psychological Association published the Clinical Practice Guidelines for the Treatment of Posttraumatic Stress Disorder (PTSD) in Adults. Although the Guideline Development Panel aimed to produce guidelines based on the best available scientific evidence, concerns were raised that the guidelines would constrain the implementation of some effective psychotherapies and limit clinician autonomy, potentially leading to coverage for only manualized, time-limited, cognitive-behavioral treatments. The following article reviews the PTSD guidelines in light of the evidence-based practice in psychology policy adopted by the American Psychological Association in 2006. We highlight the strengths of the guidelines as currently written while recognizing areas in which the guidelines do not meet evidence-based practice in psychology recommendations. A clinical vignette of the treatment of a complex patient with PTSD and significant comorbidities is provided to illustrate the difficulty of clinical decision-making and how the guidelines may complicate the delivery of effective treatments. We conclude with recommendations on how to consider a broad range of research evidence, appropriately integrate clinician expertise, and better appreciate the role of patient values and preferences in PTSD treatment decision-making. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Silver KE; Levant RF
Psychotherapy
2019
2019-09
Copyright © 2019. Published by Elsevier Inc.
journalArticle
<a href="http://doi.org/10.1037/pst0000230" target="_blank" rel="noreferrer noopener">10.1037/pst0000230</a>
PMID: 31282711
Development and evaluation of a new short form of the conformity to masculine norms inventory (CMNI-30).
The Conformity to Masculine Norms Inventory (CMNI) has been an important tool in researching masculinity. With the original measure at 94 items (Mahalik et al., 2003), there have been several abbreviated forms developed from 11 to 55 items. However, in confirmatory factor analyses (CFA's) testing 13 common factors, bifactor, hierarchical, and unidimensional models, only 4 models demonstrated adequate fit to the data, and most of these were for the still quite long 46-item version. As a result, there was no psychometrically strong truly short form of the CMNI. In the present study, data from 1561 community and university men were used to develop a short form. First an exploratory factor analysis using a portion of the data was conducted, which resulted in a 10-subscale dimensionality, followed by CFA estimating a common factors model. The results of the CFA were used to create two candidate models for a 30-item short form of the CMNI, based on Classical test theory (CTT) and optimized CTT. The best-fitting candidate model for the CMNI-30 was CTT. Next, the fit of the 29, 46, and 94 item models were compared to the 30-item version, which had the superior fit. Then, measurement invariance between White men and men of color was assessed, choosing this comparison because hegemonic masculinity is theorized to marginalize men of color. Evidence was found for full configural and metric, and partial scalar and residuals invariance. Finally, significant relationships between CMNI-30 scores and indicators of depression and anxiety provides preliminary concurrent evidence for its validity. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
Levant RF; McDermott R; Parent MC; Alshabani N; Mahalik JR; Hammer JH
Journal of counseling psychology
2020
2020-02-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1037/cou0000414" target="_blank" rel="noreferrer noopener">10.1037/cou0000414</a>
PMID: 32011153
Reading for pandemic: Viral modernism by Elizabeth Outka, New York: Columbia University Press, 2020.
Bracken RC
The Journal of Medical Humanities
2020
2020-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1007/s10912-020-09638-2" target="_blank" rel="noreferrer noopener">10.1007/s10912-020-09638-2</a>
Update to the society of radiologists in ultrasound liver elastography consensus statement.
This multidisciplinary update of the Society of Radiologists in Ultrasound consensus statement on liver elastography incorporates the large volume of new information available in the literature since the initial publication. The recommended procedure for acquiring stiffness measurements is reviewed. There has been substantial improvement in the acoustic radiation force impulse (ARFI) technology-most notably the addition of a quality assessment of the shear wave propagation. Due to the efforts of the Quantitative Imaging Biomarkers Alliance, or QIBA, the variability of liver stiffness measurements between systems had decreased. There are now effective treatments for hepatitis B and hepatitis C, and follow-up after effective treatment should be based on the use of the delta change of the value obtained at viral eradication or suppression. Because the detection of compensated advanced chronic liver disease (cACLD) is very important, the new guidelines are made based on the probability of cACLD for given stiffness values. The panel recommends a vendor-neutral rule of four for interpretation for ARFI techniques. This new method simplifies interpretation of liver stiffness results and is more clinically relevant.
Barr RG; Wilson SR; Rubens D; Garcia-Tsao G; Ferraioli G
Radiology
2020
2020-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1148/radiol.2020192437" target="_blank" rel="noreferrer noopener">10.1148/radiol.2020192437</a>
Reimagining proactive strategic planning toward patient-centered care: processes and outcomes in a medical school's department of family and community medicine
Clinical leadership; Family medicine; Health professions; Medical education; Organizational development for effective clinical governance; Organizational learning; Primary care
Purpose A detailed strategic planning process is presented that entails several beneficial and effective strategies and goals for interdisciplinary academic, clinical and/or service departments. This strategic planning process emerged due to the need to adapt to organizational and structural changes within an institution of higher medical education. Design/methodology/approach A strategic planning framework was developed, along with an inclusive process that used an appreciative inquiry methodology, to examine past and present strengths and potentials in a diverse, interdisciplinary family and community medicine department. Findings The success of this strategic plan and relevant approaches is evidenced by the development of a community medicine course, student-run free clinic to meet the needs of underserved patients, an increase in primary care research and increase in student choice of family medicine as specialty choice. Research limitations/implications The described strategic planning process serves as an illustration of the benefits and limitations of identified approaches and outcomes useful for other departments and organizations undertaking similar efforts. Originality/value The integration of multiple goals and a shared vision in a strategic planning process leads to successful program development and meeting the needs of future healthcare professionals and the patients and communities they serve. The authors have provided a model for such success.
Aultman Julie; Kingsbury Diana; Baughman Kristin; Fischbein Rebecca; Boltri John M.
International Journal of Health Governance
2020
05-2020
This manuscript is licensed under a <a href="https://creativecommons.org/licenses/by-nc/4.0/" target="_blank" rel="noreferrer noopener">Creative Commons Attribution Non-commercial International Licence 4.0 (CC BY-NC 4.0)</a>. Any reuse is allowed in accordance with the terms outlined by the licence. To reuse the AAM for commercial purposes, permission should be sought by contacting <a href="mailto:permissions@emeraldinsight.com">permissions@emeraldinsight.com</a>
This article has been made available according to Emerald publishing's decision to remove the embargo period across all journals for the self-archiving of articles according to a green open access model.
Journal Article
<a href="https://doi.org/10.1108/IJHG-03-2020-0017" target="_blank" rel="noreferrer noopener">10.1108/IJHG-03-2020-0017</a>
Facilitating Narrative Change in Career Construction Counseling
career construction counseling; client change; elaborating change; evoking change; innovative moments
Career Construction Counseling fosters client change by evoking and elaborating innovative moments in client narratives. In this article, we describe four types of dialogues that counselors may use to prompt narrative novelty and foster client change: (a) identify and evaluate the effects of innovative moments, (b) highlight contrasting self-positions, (c) ask about changes achieved, (d) promote a meta-perspective on change. Vignettes from a case are used to illustrate how to use IM markers as a heuristic guide for when to engage in these four types of dialogues.
Cardoso Paulo Miguel; Savickas Mark L; Goncalves Mario Miguel
Journal of Career Development
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1177/0894845319898872" target="_blank" rel="noreferrer noopener">10.1177/0894845319898872</a>