The need for a holistic approach for SSc-ILD - achievements and ambiguity in a devastating disease

Systemic sclerosis (SSc) is a multi-organ autoimmune disease with complex interactions between immune-mediated inflammatory processes and vascular pathology leading to small vessel obliteration, promoting uncontrolled fibrosis of skin and internal organs. Interstitial lung disease (ILD) is a common but highly variable manifestation of SSc and is associated with high morbidity and mortality. Treatment approaches have focused on immunosuppressive therapies, which have shown some efficacy on lung function. Recently, a large phase 3 trial showed that treatment with nintedanib was associated with a reduction in lung function decline. None of the conducted randomized clinical trials have so far shown convincing efficacy on other outcome measures including quality of life determined by patient reported outcomes. Little evidence is available for non-pharmacological treatment and supportive care specifically for SSc-ILD patients, including pulmonary rehabilitation, supplemental oxygen, symptom relief and adequate information. Improved management of SSc-ILD patients based on a holistic approach is necessary to support patients in maintaining as much quality of life as possible throughout the disease course and to improve long-term outcomes.

A Conceptual Justification for Brain Death

Among the old and new controversies over brain death, none is more fundamental than whether brain death is equivalent to the biological phenomenon of human death. Here, I defend this equivalency by offering a brief conceptual justification for this view of brain death, a subject that Andrew Huang and I recently analyzed elsewhere in greater detail. My defense of the concept of brain death has evolved since Bernard Gert, Charles Culver, and I first addressed it in 1981, a development that paralleled advances in intensive care unit treatment. The century-old concept of the organism as a whole provides the fundamental justification for the equivalency of brain death and human death. In our technological age, in which increasing numbers of components and systems of an organism can be kept alive, and for longer intervals, the permanent cessation of functioning of the organism as a whole is the phenomenon that best corresponds to its death.

Defining Social Work within Holistic Public Defense: Challenges and Implications for Practice

Social work has a history of forensic practice, but social work as an integral component of the holistic model of public defense is new and is creating a demand for better definition of roles and services. The intent of this article is to contribute to and encourage dialogue surrounding social work practice within the holistic public defense model. A brief overview of the indigent criminal defense system and its emerging models of defense practice is provided. Models of practice established by the Knox County Public Defender's Community Law Office are offered. Challenges, implications, and future directions are discussed.

Taking a holistic approach to managing difficult stress fractures

Stress fractures and other bony stress injuries occur along a spectrum of severity which can impact treatment and prognosis. When treating these injuries, it should be borne in mind that no two stress fractures behave exactly alike. Given that they are not a consistent injury, standardized treatment protocols can be challenging to develop. Treatment should be individualized to the patient or athlete, the causative activity, the anatomical site, and the severity of the injury. A holistic approach to the treatment of the most difficult stress fractures should be taken by orthopedists and sports medicine specialists. This approach is necessary to obtain optimal outcomes, minimize loss of fitness and time away from sports participation, and decrease the risk of recurrence.

Medical student mandala making for holistic well-being

The objective of this qualitative research study was to discover how creating mandalas (art made in reference to a circle) might provide medical students with an opportunity for reflection on their current psychological state. As part of their year 3 family medicine rotation, medical students participated in an art-making workshop, during which, they created mandalas based on their current emotional state. Afterwards, they engaged in reflective writing and discussion. The responses of 180 students were analysed and coded according to the mandala classification framework 'Archetypal Stages of The Great Round of Mandala'. The results indicated that students were actively struggling in integrating conflicting perspectives as they were attempting to reconcile their professional identity as doctors. Additional results pertaining to psychosocial characteristics included navigating difficult emotions, requiring nurturance, handling endings, contemplating existential concerns and managing stress. The study has implications for making use of mandala making within a Jungian framework as means for medical students to reflect on their emotional state and achieve psychological balance.

[The first 25 years of oncopsychology at the National Institute of Oncology: antecedents and events (1988-2013)]

The first oncopsychological department was established in National Institute of Oncology by Sándor Eckhardt in 1988. At an early stage the specialists who were interested in mental hygiene made a united effort with Katalin Muszbek's oncopsychologic group. Ágnes Riskó was the first specialist who seceded from this group, and she became a permanent member of the onco-hematology group in 1992. Due to the universalized approach, the psyhcologist would become a permanent member of onco-team. The overhand and increasing multidisciplinary cooperation enable to use this accepted method in the daily medical treatment. When necessary, patients' relatives may come in for treatment and this method can help for medical stuff to avoid burnout. As a result of oncopsychology techniques and cooperation of oncologic teamwork the integration of psychosocial intervention into a complex oncologic treatment has already begun. The attendance of supervised onco-psychological specialists is being increased. Our activity contributes to improve our patients' psychosocial standard of living, their cooperation with the medical staff and the atmosphere of oncologic departments. The integration of the approach and methods of psychosocial rehabilitation into the new oncologic professional guideline has also begun.

Moving toward a holistic conceptual framework for understanding healthy aging among gay men

In the last four decades, we have witnessed vast and important transitions in the social, economic, political, and health contexts of the lived experiences of gay men in the United States. This dynamic period, as evidenced most prominently by the transition of the gay rights movement to a civil rights movement, has shifted the exploration of gay men's health from one focusing primarily on HIV/AIDS into a mainstream consideration of the overall health and wellbeing of gay men. Against this backdrop, aging gay men in the United States constitute a growing population, for whom further investigations of health states and health-related disparities are warranted. In order to advance our understanding of the health and wellbeing of aging gay men, we outline here a multilevel, ecosocial conceptual framework that integrates salient environmental, social, psychosocial, and sociodeomgraphic factors into sets of macro-, meso-, and micro-level constructs that can be applied to comprehensively study health states and health care utilization in older gay men.

Kaleidoscope model of diabetes care: time for a rethink?

National Audit Data highlight persistent sub-optimum control among increasing numbers of people living with diabetes, with severe consequences for the individual and the NHS. The aim of the present review was to introduce a new cohesive, holistic model of care, tailored to individual needs to support optimum diabetes outcomes. This model of diabetes is necessary in order to understand the driving forces behind behaviour and their impact on diabetes management. Feelings (an emotional state or reaction) and beliefs (an acceptance that something is true or real) are fundamental behavioural drivers and influence diabetes self-management choices. Individually, these explain some of the complexities of behaviour and, collectively, they impact on personal motivation (rationale/desire to act) to achieve a specific outcome. Inevitably, they independently affect diabetes self-management and the environment in which individuals live. A model of care that proposes the encompassing of environment, intrinsic thought and therapy regimens to provide tailored, personalized healthcare should support enhanced diabetes self-management and outcomes from diagnosis. The Kaleidoscope model of care could be deliverable in routine care, incorporating each of the influences on diabetes self-management, and should benefit both individuals with diabetes and healthcare professionals.

[Which way ahead for psychiatry? Identity, competence and cooperation--challenges of the 21st century]

In the past decades some disadvantageous changes have been occurred in almost each field of medicine, especially neurology and psychiatry. Medical students and young doctors are less and less able to utilize their neurological knowledge in the everyday clinical practice and the number of doctors specialized in neurosciences is decreasing. Recent problems of psychiatry originate from special development, controversial process of detachment, particular societal and cultural roots, differences from medical model, and problems of identity, self-determination and competence, which may cause many difficulties in clinical practice. The author - near the review of the theoretical background - mentions several practical topics as well, for example: the difficulties of diagnosing, and classification of mental disorders, the diagnostic and treating problems being in the background of psychopathological symptoms. In the article it is emphasized that the present situation results in several serious problems for the psychiatrists like emotional overburden, somatic and mental disorders and burnout, moreover psychiatry became one of the least popular medical professions, which causes huge difficulties in the aftergrowth. Furthermore the author emphasises, that this profession has to actualize the humanistic view in clinical practice based on the holistic bio-psycho-socio-spiritual approach. The (neuro)scientific and consultative psychiatric viewpoints, the constructive intra- and interdisciplinary communication, the more effective value-based advocacy and the modern, evidence-based, interactive and personal education together have a key role in the solution of the above mentioned problems.