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Ashana DC, Welsh W, Preiss D, Sperling J, You H, Tu K, Carson SS, Hough C, White DB, Kerlin M, Docherty S, Johnson KS, Cox CE. Racial Differences in Shared Decision-Making About Critical Illness. JAMA Intern Med 2024; 184:424-432. [PMID: 38407845 PMCID: PMC10897823 DOI: 10.1001/jamainternmed.2023.8433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/18/2023] [Indexed: 02/27/2024]
Abstract
Importance Shared decision-making is the preferred method for evaluating complex tradeoffs in the care of patients with critical illness. However, it remains unknown whether critical care clinicians engage diverse patients and caregivers equitably in shared decision-making. Objective To compare critical care clinicians' approaches to shared decision-making in recorded conversations with Black and White caregivers of patients with critical illness. Design, Setting, and Participants This thematic analysis consisted of unstructured clinician-caregiver meetings audio-recorded during a randomized clinical trial of a decision aid about prolonged mechanical ventilation at 13 intensive care units in the US. Participants in meetings included critical care clinicians and Black or White caregivers of patients who underwent mechanical ventilation. The codebook included components of shared decision-making and known mechanisms of racial disparities in clinical communication. Analysts were blinded to caregiver race during coding. Patterns within and across racial groups were evaluated to identify themes. Data analysis was conducted between August 2021 and April 2023. Main Outcomes and Measures The main outcomes were themes describing clinician behaviors varying by self-reported race of the caregivers. Results The overall sample comprised 20 Black and 19 White caregivers for a total of 39 audio-recorded meetings with clinicians. The duration of meetings was similar for both Black and White caregivers (mean [SD], 23.9 [13.7] minutes vs 22.1 [11.2] minutes, respectively). Both Black and White caregivers were generally middle-aged (mean [SD] age, 47.6 [9.9] years vs 51.9 [8.8] years, respectively), female (15 [75.0%] vs 14 [73.7%], respectively), and possessed a high level of self-assessed health literacy, which was scored from 3 to 15 with lower scores indicating increasing health literacy (mean [SD], 5.8 [2.3] vs 5.3 [2.0], respectively). Clinicians conducting meetings with Black and White caregivers were generally young (mean [SD] age, 38.8 [6.6] years vs 37.9 [8.2] years, respectively), male (13 [72.2%] vs 12 [70.6%], respectively), and White (14 [77.8%] vs 17 [100%], respectively). Four variations in clinicians' shared decision-making behaviors by caregiver race were identified: (1) providing limited emotional support for Black caregivers, (2) failing to acknowledge trust and gratitude expressed by Black caregivers, (3) sharing limited medical information with Black caregivers, and (4) challenging Black caregivers' preferences for restorative care. These themes encompass both relational and informational aspects of shared decision-making. Conclusions and Relevance The results of this thematic analysis showed that critical care clinicians missed opportunities to acknowledge emotions and value the knowledge of Black caregivers compared with White caregivers. These findings may inform future clinician-level interventions aimed at promoting equitable shared decision-making.
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Affiliation(s)
- Deepshikha C. Ashana
- Department of Medicine, Duke University, Durham, North Carolina
- Duke-Margolis Center for Health Policy, Duke University, Durham, North Carolina
- Department of Population Health Sciences, Duke University, Durham, North Carolina
| | - Whitney Welsh
- Social Science Research Institute, Duke University, Durham, North Carolina
| | - Doreet Preiss
- Social Science Research Institute, Duke University, Durham, North Carolina
| | - Jessica Sperling
- Social Science Research Institute, Duke University, Durham, North Carolina
| | - HyunBin You
- School of Nursing, Duke University, Durham, North Carolina
| | - Karissa Tu
- School of Medicine, University of Washington, Seattle
| | | | - Catherine Hough
- Department of Medicine, Oregon Health and Science University, Portland
| | - Douglas B. White
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Meeta Kerlin
- Department of Medicine, University of Pennsylvania, Philadelphia
| | | | - Kimberly S. Johnson
- Department of Medicine, Duke University, Durham, North Carolina
- Geriatrics Research Education and Clinical Center (GRECC), Durham Veterans Affairs Healthcare System, Durham, North Carolina
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Anderson JN, Paladino AJ, Blue R, Dangerfield DT, Eggly S, Martin MY, Schwartzberg LS, Vidal GA, Graetz I. Silent suffering: the impact of sexual health challenges on patient-clinician communication and adherence to adjuvant endocrine therapy among Black women with early-stage breast cancer. J Cancer Surviv 2023:10.1007/s11764-023-01511-0. [PMID: 38114711 DOI: 10.1007/s11764-023-01511-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 12/05/2023] [Indexed: 12/21/2023]
Abstract
PURPOSE Adjuvant endocrine therapy (AET) increases sexual health challenges for women with early-stage breast cancer. Black women are more likely than women of other racial/ethnic groups to report adverse symptoms and least likely to initiate and maintain AET. Little is known about how sexual health challenges influence patient-clinician communication and treatment adherence. This study explores facilitators of and barriers to patient-clinician communication about sexual health and how those factors might affect AET adherence among Black women with early-stage breast cancer. METHODS We conducted 32 semi-structured, in-depth interviews among Black women with early-stage breast cancer in the U.S. Mid-South region. Participants completed an online questionnaire prior to interviews. Data were analyzed using thematic analysis. RESULTS Participants' median age was 59 (range 40-78 years, SD = 9.0). Adverse sexual symptoms hindered participants' AET adherence. Facilitators of patient-clinician communication about sexual health included female clinicians and peer support. Barriers included perceptions of male oncologists' disinterest in Black women's sexual health, perceptions of male oncologists' biased beliefs about sexual activity among older Black women, cultural norms of sexual silence among Southern Black women, and medical mistrust. CONCLUSIONS Adverse sexual symptoms and poor patient-clinician communication about sexual health contribute to lower AET adherence among Black women with early-stage breast cancer. New interventions using peer support models and female clinicians trained to discuss sexual health could ameliorate communication barriers and improve treatment adherence. IMPLICATIONS FOR CANCER SURVIVORS Black women with early-stage breast cancer in the U.S. Mid-South may require additional resources to address sociocultural and psychosocial implications of cancer survivorship to enable candid discussions with oncologists.
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Affiliation(s)
- Janeane N Anderson
- College of Nursing, University of Tennessee Health Science Center, 874 Union Avenue, Memphis, TN, 38163, USA.
| | - Andrew J Paladino
- College of Medicine, University of Tennessee Health Science Center, 910 Madison Avenue, Memphis, TN, 38103, USA
| | - Ryan Blue
- College of Nursing, University of Tennessee Health Science Center, 874 Union Avenue, Memphis, TN, 38163, USA
| | - Derek T Dangerfield
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave. NW #308, Washington, D.C, 20037, USA
| | - Susan Eggly
- Department of Oncology, School of Medicine, Wayne State University, 87 E. Canfield, Detroit, MI, 48201, USA
| | - Michelle Y Martin
- Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, 66 N. Pauline Street, Memphis, TN, 38163, USA
| | | | - Gregory A Vidal
- West Cancer Center Research Institute, 7945 Wolf River Blvd, Germantown, TN, 38138, USA
| | - Ilana Graetz
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
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Bäckryd E. The benefits and risks of nostalgia: analysis of a fictional case with special reference to ethical and existential issues. Philos Ethics Humanit Med 2023; 18:3. [PMID: 37072749 PMCID: PMC10114357 DOI: 10.1186/s13010-023-00132-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 04/03/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND In a previous paper in Philos Ethics Humanit Med, the 1937 Swedish novel Sömnlös (Swedish for sleepless) by Vilhelm Moberg was used as background for a thought experiment, in which last century's progresses concerning the safety of sleeping pills were projected into the future. This gave rise to a theoretical discussion about broad medico-philosophical questions such as (among other things) the concept of pharmaceuticalisation. METHODS In this follow-up paper, the theme of insomnia in Sömnlös is complemented by a discussion of the concept of nostalgia. The core of the paper is a theoretical discussion about the benefits and risks of nostalgia, bringing together some aspects of recent psychological research about the construct of nostalgia with the main story line of the novel. RESULTS AND CONCLUSION Nostalgia is portrayed as being, in some sense at least, ultimately beneficial for the protagonist of Sömnlös. This is congruent with recent psychological research. However, the story also shows that nostalgia may lead to problematic behaviours, at least when viewed from a virtue ethics perspective. Hence, nostalgia is both what leads the protagonist into ethically problematic behaviour and that which (paradoxically) ultimately saves him from his initial lack of courage, justice, temperance and practical wisdom. Moreover, the protagonist does not only "grow" ethically but also existentially. Hence, the novel opens up the possibility that insomnia and nostalgia might be viewed as bearers of important existential information (cf. sociologist of religion Peter L. Berger and his concept of "signals of transcendence").
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Affiliation(s)
- Emmanuel Bäckryd
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, SE-581 85 Linköping, Sweden.
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Boragno P, Fiabane E, Colledani D, Dalla Gasperina D, Setti I, Sommovigo V, Gabanelli P. Attitude towards Intranasal Vaccines and Psychological Determinants: Effects on the General Population in Northern Italy. Vaccines (Basel) 2023; 11:vaccines11010138. [PMID: 36679983 PMCID: PMC9863592 DOI: 10.3390/vaccines11010138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/02/2023] [Accepted: 01/06/2023] [Indexed: 01/10/2023] Open
Abstract
Little is known about the use of intranasal vaccines, but some studies have shown that this innovative way of administration is preferred over needle injection as it is considered both less painful and intrusive to the body, equally effective, and associated with fewer side effects. This study aimed to investigate specific psychological determinants (intolerance of uncertainty, persecutory ideation, perceived control, vaccine hesitancy) of attitude toward nasal vaccine delivery. A convenience sample including 700 Italian participants took part in this cross-sectional study and completed an online questionnaire. A structural equation model with a latent variable was performed to study the relationship between psychological variables, vaccine hesitancy, and attitude toward nasal vaccine delivery. The results indicate that both a hesitant attitude toward vaccination (β = 0.20, p = 0.000) and low perceived control (β = -0.20, p = 0.005) may directly increase preference for nasal administration; furthermore, high levels of persecutory ideation may indirectly influence the propensity for intranasal vaccine. These findings suggest that pharmaceutical companies could implement nasal vaccines and provide detailed information on these vaccines through informational campaigns. Hesitant individuals with low levels of perceived control could more easily comply with these types of vaccines.
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Affiliation(s)
- Paola Boragno
- Istituti Clinici Scientifici Maugeri IRCCS, Psychology Unit of Pavia Institute, 27100 Pavia, Italy
| | - Elena Fiabane
- Istituti Clinici Scientifici Maugeri IRCCS, Department of Physical and Rehabilitation Medicine of Genova Nervi Institute, 16121 Genova, Italy
- Correspondence:
| | - Daiana Colledani
- Department of Philosophy, Sociology, Education and Applied Psychology, University of Padua, 35139 Padua, Italy
| | - Daniela Dalla Gasperina
- Azienda Socio-Sanitaria Territoriale dei Sette Laghi, Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy
| | - Ilaria Setti
- Unit of Applied Psychology, Department of Brain and Behavioural Sciences, University of Pavia, 27100 Pavia, Italy
| | - Valentina Sommovigo
- Department of Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, 00185 Roma, Italy
| | - Paola Gabanelli
- Istituti Clinici Scientifici Maugeri IRCCS, Psychology Unit of Pavia Institute, 27100 Pavia, Italy
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5
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Braxton C, Begian-Lewis KM, Marback R, Fritz H. Pain, No Gain?: A Narrative Analysis Exploring the Accounts of Older African American Patients and Their Discussion of Pain Management Related to Chronic Illness. Rhetor Health Med 2023; 6:217-240. [PMID: 38362507 PMCID: PMC10868708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
Drawing from interviews conducted as part of a study of older African Americans with multimorbidity, we argue how various forms of racism work together to shape communication between doctors and patients. By focusing on what patients say about pain, we highlight patient descriptions of their relationships with pain management, their interactions with healthcare providers, and how they navigate understanding their chronic conditions. Our documentation of patient experience with stigmas and biases suggests what is needed for more empathetic and effective communication within the doctor and patient relationship. We conclude by using the interview data to propose addressing racial inequality in health care in the United States through educational reform and training initiatives grounded in rhetorical research.
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Affiliation(s)
| | | | | | - Heather Fritz
- Associate Professor and Founding Director of the Pacific Northwest University of Health Sciences School of Occupational Therapy
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Yuan B, Huang X, Li J, He L. Socioeconomic disadvantages and vulnerability to the pandemic among children and youth: A macro-level investigation of American counties. Child Youth Serv Rev 2022; 136:106429. [PMID: 35221406 PMCID: PMC8864086 DOI: 10.1016/j.childyouth.2022.106429] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 04/27/2021] [Accepted: 02/19/2022] [Indexed: 06/14/2023]
Abstract
This study intends to reveal the underlying structural inequity in vulnerability to infection of the novel coronavirus disease pandemic among children and youth. Using multi-source data from New York Times novel coronavirus disease tracking project and County Health Rankings & Roadmap Program, this study shows that children and youth in socioeconomically disadvantaged status are faced with disproportionate risk of infection in this pandemic. On the county level, socioeconomic disadvantages (i.e., single parent family, low birthweight, severe housing problems) contribute to the confirmed cases and death cases of the novel coronavirus disease. Policymakers should pay more attention to this vulnerable group to implement more targeted and effective epidemic prevention and control.
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Affiliation(s)
- Bocong Yuan
- School of Tourism Management, Sun Yat-sen University, Guangzhou, China
| | - Xinting Huang
- School of Management, Xi'an Jiaotong University, Xi'an, China
| | - Jiannan Li
- Institute of Advanced Studies in Humanities and Social Sciences, Beijing Normal University, Zhuhai, China
| | - Longtao He
- Research Institute of Social Development, Southwestern University of Finance and Economics, Chengdu, China
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7
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Messas G, Fukuda L, Fulford KWM. The Dialectics of Altered Experience: How to Validly Construct a Phenomenologically Based Diagnosis in Psychiatry. Front Psychiatry 2022; 13:867706. [PMID: 35492704 PMCID: PMC9039225 DOI: 10.3389/fpsyt.2022.867706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
In this paper, we present how a dialectical perspective on phenomenological psychopathology, called Dialectical Phenomenology (DPh), can contribute to current needs of psychiatric diagnosis. We propose a three-stage diagnostic methodology: first- and second-person stages, and synthetic hermeneutics stage. The first two stages are divided into a pre-dialectical and a dialectical phase. The diagnostic process progresses in a trajectory of increasing complexity, in which knowledge obtained at one level is dialectically absorbed and intertwined into the next levels. Throughout the article, we offer some examples of each step. In overall, the method starts off from the patient's own narrative, proceeds to two stages of phenomenological reduction designed to guarantee the scientific validity of the object, and concludes with a hermeneutical narrative synthesis that is dialectically composed of the patient's and psychopathologist's shared narratives. At the end of this process, the initial first-person narrative is transformed into a specific scientific object, a full dialectical phenomenological psychiatric diagnosis. This form of diagnosis constitutes a comprehensive alternative for an integral assessment of the complexities of human psychological alteration, bringing together both the interpretation of the suffering person and the scientific categories of psychiatry.
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Affiliation(s)
- Guilherme Messas
- Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil.,Collaborating Centre for Values-Based Practice, St Catherine's College, Oxford, United Kingdom
| | - Lívia Fukuda
- Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - K W M Fulford
- Collaborating Centre for Values-Based Practice, St Catherine's College, Oxford, United Kingdom.,Philosophy Faculty, St Catherine's College, University of Oxford, Oxford, United Kingdom.,Philosophy and Mental Health, University of Warwick, Coventry, United Kingdom
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8
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Teelin KL, Shubkin CD, Caruso Brown AE. Conscientious Objection to Providing Gender Health Care in Pediatric Training: Balancing the Vulnerability of Transgender Youth and the Vulnerability of Pediatric Residents. J Pediatr 2022; 240:272-279. [PMID: 34547338 DOI: 10.1016/j.jpeds.2021.09.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 08/23/2021] [Accepted: 09/13/2021] [Indexed: 10/20/2022]
Abstract
Within pediatric graduate medical education, the care of transgender youth presents opportunities for deepening learners' understanding of equity, access, the role of the physician as an advocate, and health disparities caused by stigma and minority stress. However, when a pediatric resident objects to providing health care to this uniquely vulnerable population owing to their personal beliefs and values, how should pediatrician-educators respond? Important reasons to respect healthcare professionals' conscience have been described in the scholarly literature; however, equally important concerns have also been raised about the extent to which conscientious objection should be permitted in a pluralistic society, particularly given power differentials that favor healthcare professionals and grants them a monopoly over certain services. In the context of medical education, however, residents are in a unique position: they are simultaneously learners and employees, and although privileged relative to their patients, they are also vulnerable in relation to the hierarchy of healthcare and of institutions. We must find a compassionate balance between nurturing the evolving conscience of students and trainees and protecting the health and well-being of our most vulnerable patients. Educators have an obligation to foster empathy, mitigate bias, and mentor their learners, regardless of beliefs, but in some cases, they may recognize that there are limits: patients' welfare ultimately takes precedence and trainees should be guided toward alternative career paths. We explore the limits of conscientious objection in medical training and propose a framework for pediatrician-educators to support learners and patients in challenging circumstances.
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Affiliation(s)
- Karen L Teelin
- Department of Pediatrics, SUNY Upstate Medical University, Syracuse, NY
| | - Catherine D Shubkin
- Department of Pediatrics, Children's Hospital at Dartmouth-Hitchcock, Lebanon, NH
| | - Amy E Caruso Brown
- Department of Pediatrics, SUNY Upstate Medical University, Syracuse, NY; Center for Bioethics and Humanities, SUNY Upstate Medical University, Syracuse, NY.
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9
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Sheng X, Ketron SC, Wan Y. Identifying consumer segments based on COVID-19 pandemic perceptions and responses. J Consum Aff 2021; 56:34-67. [PMID: 34908579 PMCID: PMC8662050 DOI: 10.1111/joca.12413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 09/06/2021] [Accepted: 09/13/2021] [Indexed: 06/14/2023]
Abstract
Consumer responses to the COVID-19 pandemic have varied widely. Thus, marketers need to understand consumer segments based on pandemic-related responses and behaviors. Through two studies conducted 9 months apart, we find that consumers shift from three segments in Study 1-the Apprehensive, the Prepared, and the Dismissive, to two segments in Study 2-the Dedicated and the Dismissive. The Apprehensive feel particularly threatened of the virus. The Prepared and the Dedicated perceive a lower susceptibility but still take the health threat seriously. The Dismissive downplay the threat and exhibit more negative reactions to mitigation measures. We also demonstrate between-segment downstream response differences. While the Apprehensive and the Prepared/Dedicated exhibit positive attitude toward companies enforcing guidelines, the Apprehensive engage in the most panic buying, hoarding, and stockpiling. The Dedicated also express greater stress and less life satisfaction than the Dismissive. The findings offer theoretical and practical implications for pandemic-related consumer responses.
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Affiliation(s)
- Xiaojing Sheng
- College of Business and EntrepreneurshipThe University of Texas Rio Grande ValleyEdinburgTexasUSA
| | - Seth C. Ketron
- New College at FriscoThe University of North TexasDentonTexasUSA
| | - Yubing Wan
- Precision for MedicineFrederickMarylandUSA
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10
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Aftab A, Waterman GS. Conceptual Competence in Psychiatry: Recommendations for Education and Training. Acad Psychiatry 2021; 45:203-209. [PMID: 31989541 DOI: 10.1007/s40596-020-01183-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 01/09/2020] [Indexed: 06/10/2023]
Affiliation(s)
- Awais Aftab
- Case Western Reserve University, Cleveland, OH, USA.
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11
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Sotomayor CR, Barrero A. Retraction Note: Globalization and vulnerable populations in times of a pandemic: A Mayan perspective. Philos Ethics Humanit Med 2020; 15:14. [PMID: 33317564 PMCID: PMC7737333 DOI: 10.1186/s13010-020-00098-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
An amendment to this paper has been published and can be accessed via the original article.
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12
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Calabrò RS, Naro A, De Luca R, Russo M, Caccamo L, Manuli A, Alagna B, Aliquò A, Bramanti P. End-Of-Life Decisions in Chronic Disorders of Consciousness: Sacrality and Dignity as Factors. NEUROETHICS-NETH 2016; 9:85-102. [DOI: 10.1007/s12152-016-9257-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
In this article we develop a phenomenological psychopathology of receding delusions in persons with a diagnosis of schizophrenia. Drawing on Klaus Conrad's (1905-1961) descriptions of beginning schizophrenia and an in-depth single case study, we develop descriptions of the process of receding delusions as opposed to ongoing delusions in the manner of a double-orientation to reality. We distinguish two stages in this process of social recovery and term these stages deactualization and orthostrophy. We argue that delusional convictions lose importance and persuasive power if they are no longer supported by corresponding value apprehensions or perceptions and perception-like experiences (i.e. hallucinations). Consequently, we propose that the process of receding delusions proceeds in layers comparable to a regression of the process of upcoming delusions. Lastly we discuss both stages of receding delusions (deactualization and orthostrophy) and ongoing delusions (double-orientation to reality) as possible continuous manners of social recovery concerning delusional psychosis (diagnosis of schizophrenia) and argue for specific interventions according to these different continuous manners.
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Affiliation(s)
- J E Schlimme
- Psychiatrische Universitätsklinik der Charité im St. Hedwig Krankenhaus, Charité Universitätsmedizin, Große Hamburger Str. 5-11, 10115, Berlin, Deutschland,
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Schlimme JE, Schwartz MA. In recovery from schizophrenia: regaining social cover - a phenomenological investigation. Psychopathology 2013; 46:102-10. [PMID: 22922502 DOI: 10.1159/000339384] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Accepted: 05/04/2012] [Indexed: 11/19/2022]
Abstract
We offer here a framework for the understanding of being in recovery from schizophrenia as an interpersonal process. We draw upon in-depth phenomenological descriptions of the fundamental changes taking place in an individual's mental life when they are suffering from schizophrenia. There is a loss of commonsensical habituality and interpersonal capabilities, usually most prominently expressed as an impaired intersubjective resonance. People with schizophrenia cannot as easily automatically and coherently display their own emotion via their facial expressions or perceive those of others, as do 'normal' people. This implies that interpersonal resonance between interacting individuals is not automatic, as is often taken for granted. The need to actively rebuild interpersonal resonance also holds true for the interacting 'normal' person, but would be an unfamiliar and unexpected task. These difficulties in empathizing provoke a mismatch in interpersonal resonance, often leading to the intuition that the person having schizophrenia lacks (explicit) self-awareness. We conclude that there is a mismatch in the form and scope of the social cover extended to the social role opportunities available in trans-Atlantic cultural settings for people with schizophrenia. Typically, these social roles imply that people with schizophrenia are unaware of themselves; however, while they often lack insight or may not consider their symptoms as signs of a mental disorder, they are usually not 'confused' or 'distracted' in the sense of no longer being aware of themselves. We discuss various options for adequate social cover achievable for people with schizophrenia, demonstrating their impact on the recovery process.
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Affiliation(s)
- Jann E Schlimme
- Psychiatric University Hospital Charité at St. Hedwig Hospital, Charité Universitätsmedizin, Berlin, Germany.
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15
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Zimmermann M. Dementia in life writing: our health care system in the words of the sufferer. Neurol Sci 2010; 32:1233-8. [DOI: 10.1007/s10072-010-0459-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Accepted: 11/20/2010] [Indexed: 01/29/2023]
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Abstract
This study examined physicians' level of satisfaction with their job and the match between expectations and actual practice of specialty. Quantitative results suggested that physicians (N = 211) had a moderately high level of overall job satisfaction with no significant differences found between men and women physicians. Among those in primary care, medical specialties, surgical specialties, or supporting specialties, overall job satisfaction was found to be higher for surgical specialists compared to primary care physicians. Qualitative comments from two open-ended questions identified 20 themes regarding how closely the participants' expectations matched with the realities of the practice of medicine. Six themes are described in detail. Approximately 85% of physicians felt their expectations for their specialty matched their actual experience in the field. Helping students to understand how their expectations align with the actual practice of medicine and specific specialties is important to their development as a physician and to job satisfaction, and has implications for career counseling and advising in undergraduate and graduate medical education.
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Halpern AL, Halpern JH, Doherty SB. "Enhanced" interrogation of detainees: do psychologists and psychiatrists participate? Philos Ethics Humanit Med 2008; 3:21. [PMID: 18817568 PMCID: PMC2561033 DOI: 10.1186/1747-5341-3-21] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2008] [Accepted: 09/25/2008] [Indexed: 05/26/2023] Open
Abstract
After revelations of participation by psychiatrists and psychologists in interrogation of prisoners at Guantánamo Bay and Central Intelligence Agency secret detention centers, the American Psychiatric Association and the American Psychological Association adopted Position Statements absolutely prohibiting their members from participating in torture under any and all circumstances, and, to a limited degree, forbidding involvement in interrogations. Some interrogations utilize very aggressive techniques determined to be torture by many nations and organizations throughout the world. This paper explains why psychiatrists and psychologists involved in coercive interrogations violate the Geneva Conventions and the laws of the United States. Whether done with ignorance of professional ethical obligations or not, these psychiatrists and psychologists have crossed an ethical barrier that may best be averted from re-occurring by teaching medical students and residents in all medical specialties about the ethics principles stemming from the 1946-1947 Nuremberg trials and the Geneva Conventions, together with the Ethics Codes of the World Medical Association and the American Medical Association; and, with regard to psychiatric residents and psychological trainees, by the teaching about The Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry and the Ethical Principles of Psychologists and Code of Conduct, respectively. In this way, all physicians and psychologists will clearly understand that they have an absolute moral obligation to "First, do no harm" to the human beings they professionally encounter.
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Affiliation(s)
| | - John H Halpern
- Laboratory for Integrative Psychiatry, McLean Hospital, Belmont, MA, USA
- McLean Hospital, 115 Mill Street, Belmont, MA 02478-9106, USA
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