Physician Wellness in Nephrology and Palliative Care

2020 ◽  
pp. 76-84
Author(s):  
Sarah Ramer ◽  
Holly Koncicki
Keyword(s):  
United States ◽  
Palliative Care ◽  
Healthcare System ◽  
Symptom Management ◽  
The United States ◽  
Physician Wellness ◽  
Communication Techniques ◽  
Prevention And Treatment ◽  
The Individual ◽  
The Impact

Among many threats to physician wellness is burnout, which is associated with negative outcomes for patients and the healthcare system, in addition to the impact it has on physicians. Data on the prevalence, predictors, and consequences of burnout among nephrologists are very limited, but evidence from various sources suggests it might be a major issue. The prevalence of burnout among palliative care physicians is better-studied and appears to vary by country, with up to 60% of palliative care physicians in the United States suffering from burnout in a recent study. Various interventions for prevention and treatment of burnout have been tried, and some have been found to be effective. Controversy exists, however, over whether the individual or the system in which the individual works is more appropriately targeted for intervention. Learning palliative care skills, such as symptom management and advanced communication techniques, might lessen burnout and increase resilience in nephrologists.

scholarly journals Impact of the COVID-19 Vaccine on Asymptomatic Infection Among Patients Undergoing Pre-Procedural COVID-19 Molecular Screening

2021 ◽  
Author(s):  
Aaron J Tande ◽  
Benjamin D Pollock ◽  
Nilay D Shah ◽  
Gianrico Farrugia ◽  
Abinash Virk ◽  
...  
Keyword(s):  
United States ◽  
Relative Risk ◽  
Healthcare System ◽  
The United States ◽  
Asymptomatic Infection ◽  
Screening Tests ◽  
Molecular Screening ◽  
Molecular Tests ◽  
Asymptomatic Individuals ◽  
The Impact

Abstract Background Several vaccines are now clinically available under emergency use authorization in the United States and have demonstrated efficacy against symptomatic COVID-19. The impact of vaccines on asymptomatic SARS-CoV-2 infection is largely unknown. Methods We conducted a retrospective cohort study of consecutive, asymptomatic adult patients (n = 39,156) within a large United States healthcare system who underwent 48,333 pre-procedural SARS-CoV-2 molecular screening tests between December 17, 2020 and February 8, 2021. The primary exposure of interest was vaccination with at least one dose of an mRNA COVID-19 vaccine. The primary outcome was relative risk of a positive SARS-CoV-2 molecular test among those asymptomatic persons who had received at least one dose of vaccine, as compared to persons who had not received vaccine during the same time period. Relative risk was adjusted for age, sex, race/ethnicity, patient residence relative to the hospital (local vs. non-local), healthcare system regions, and repeated screenings among patients using mixed effects log-binomial regression. Results Positive molecular tests in asymptomatic individuals were reported in 42 (1.4%) of 3,006 tests performed on vaccinated patients and 1,436 (3.2%) of 45,327 tests performed on unvaccinated patients (RR=0.44 95% CI: 0.33-0.60; p<.0001). Compared to unvaccinated patients, the risk of asymptomatic SARS-CoV-2 infection was lower among those >10 days after 1 st dose (RR=0.21; 95% CI: 0.12-0.37; p<.0001) and >0 days after 2 nd dose (RR=0.20; 95% CI: 0.09-0.44; p<.0001) in the adjusted analysis. Conclusions COVID-19 vaccination with an mRNA-based vaccine showed a significant association with a reduced risk of asymptomatic SARS-CoV-2 infection as measured during pre-procedural molecular screening. The results of this study demonstrate the impact of the vaccines on reduction in asymptomatic infections supplementing the randomized trial results on symptomatic patients.

scholarly journals Understanding “nostalgic inequality”: A critical analysis of barriers to Latinos’ healthy eating practices in the United States

2017 ◽  
Vol 3 (1) ◽  
pp. 58
Author(s):  
Anahi Viladrich
Keyword(s):  
United States ◽  
New York ◽  
Healthy Eating ◽  
Minority Groups ◽  
The United States ◽  
Raising Awareness ◽  
The Individual ◽  
Eating Practices ◽  
First And Second Generation ◽  
The Impact

Based on two mixed-methods studies conducted with first and second generation Latinas in New York City (NYC), this article questions simplistic notions of acculturation by stressing the impact of structural conditions (at the individual, social and physical levels) in determining Latinas’ food practices in the United States (U.S.). The term “nostalgic inequality” is used here to argue that Latinas’ retention of, and adaptation to, their traditional staples (i.e., nostalgic foods) tends to favor affordable and fat-saturated items (e.g., fried and processed foods) that through time contribute to higher rates of obesity and cardiovascular disease, among other deleterious health conditions. In the end, this review is aimed at raising awareness about the barriers to healthy eating experienced by disadvantaged minority groups in the U.S. urban milieu.

scholarly journals Sex-Selection in India and the United States: A Contextualist Feminist Approach

2017 ◽  
Author(s):  
Sital Kalantry
Keyword(s):  
United States ◽  
Sex Discrimination ◽  
The United States ◽  
Sex Selection ◽  
Foreign Affairs ◽  
Global Perspective ◽  
Women's Equality ◽  
Individual Woman ◽  
The Individual ◽  
The Impact

Seven states in the United States have passed sex selection abortion bans, bills are pending in several other states, and a bill has been reintroduced in the U.S. Congress. In analyzing state legislative hearings, this article documents how the wide-spread practice of sex selection in other countries, particularly India and China, is being used by anti-abortion groups as a way to restrict women's right to autonomy in the United States. The dominant feminist paradigm in the United States takes a universal position on sex selection bans - these bans contravene women's right to autonomy and should not be permitted in any country. But engaging with the true realities of the situation in India, it is clear that sex selection in favor of boys does raise concerns for women's equality. This article develops a feminist framework to understand sex selection from a global perspective. This approach prioritizes individual women's autonomy, but suggests that the context in which sex selection occurs should be taken into account and the impact of sex selection on women as a group must be considered.Statutes in the United States that ban sex selection abortion are framed as protecting the fetus from sex discrimination. The contextualist feminist approach, on the other hand, focuses the conversation on the equality of women and girls who are already born. The intent of the individual woman who sex selects is no longer the focus, but the impact (if any) that it has on the equality of girls and women as a group should be the relevant criterion for determining whether or not sex selection should be limited.Published: Sital Kalantry, "Sex Selection in the United States and India: A Contextualist Feminist Approach", 18 UCLA Journal of International Law and Foreign Affairs (2013).

scholarly journals Cultures of light: Electric light in the United States, 1890s-1950s

2021 ◽  
Author(s):  
◽  
Margaret Maile Petty
Keyword(s):  
United States ◽  
Twentieth Century ◽  
Large Scale ◽  
Cultural Beliefs ◽  
The United States ◽  
Light Industry ◽  
Electric Light ◽  
American Society ◽  
The Individual ◽  
The Impact

<p>Cultures of Light is set within a period that stretches from the late nineteenth to the mid-twentieth century in the United States, an era in which nearly every aspect of American life was impacted to a lesser or greater degree by the introduction, distribution and integration of electric power and light. By no means attempting to comprehensively examine the impact and effects of this expansive transformation, this thesis has a narrow but meaningful target, defined by key intersections of electric lighting and American culture. Primarily concerned with the investigation of culturally bound ideas and practices as mediated through electric light and its applications, my thesis is focused on particular instances of this interplay. These include its role in supporting nationalizing narratives and agendas through large-scale demonstrations at world’s fairs and exhibitions, in the search for and expression of modernism and its variations in the United States. Similarly electricity and electric light throughout the better part of the twentieth century was scaled to the level of the individual through a number of mechanisms and narratives. Most prominently the electric light industry employed gendered discourses, practices and beliefs in their efforts to grow the market, calling upon the assistance of a host of cultural influencers, from movie stars to architects to interior designers, instigating a renegotiation of established approaches to the design of architecture and the visual environment. Connecting common themes and persistent concerns across these seemingly disparate subject areas through the examination of cultural beliefs, practices, rituals and traditions, Cultures of Light seeks to illustrate the deep and lasting significance of electric light within American society in the twentieth century.</p>

scholarly journals Impact of COVID-19 Second Wave on Healthcare Networks in the United States

2020 ◽  
Author(s):  
Emad M. Hassan ◽  
Hussam Mahmoud
Keyword(s):  
United States ◽  
Healthcare System ◽  
The United States ◽  
Healthcare Systems ◽  
Mitigation Strategies ◽  
County Level ◽  
Protective Measures ◽  
The Impact ◽  
Second Wave ◽  
The U.S

The risk of overwhelming healthcare systems from a second wave of COVID-19 is yet to be quantified. Here, we investigate the impact of different reopening scenarios of states around the U.S. on COVID-19 hospitalized cases and the risk of overwhelming the healthcare system while considering resources at the county level. We show that the second wave might involve an unprecedented impact on the healthcare system if an increasing number of the population becomes susceptible and/or if the various protective measures are discontinued. Furthermore, we explore the ability of different mitigation strategies in providing considerable relief to the healthcare system. The results can aid healthcare planners, policymakers, and state officials in making decisions on additional resources required and on when to return to normalcy.

Trends in Published Palliative Care Research: A 15-Year Review

2020 ◽  
pp. 104990912094486
Author(s):  
Ambereen K. Mehta ◽  
Rishi Patel ◽  
Dheer Patel ◽  
Mellar P. Davis
Keyword(s):  
Palliative Care ◽  
Symptom Management ◽  
Palliative Medicine ◽  
The United States ◽  
Management Journal ◽  
Time Points ◽  
Professional Degree ◽  
Study Type ◽  
The Impact ◽  
Published Research

Background: There has been a call for palliative care (PC) published research to support the impact and need for more specialty PC services. Objective: The purpose of this study was to characterize research in PC over a 15-year period in 3 PC journals published in the United States. Design: The authors reviewed every issue of the Journal of Pain and Symptom Management, Journal of Palliative Medicine, and American Journal of Hospice and Palliative Medicine from 2004 through 2018. Studies included were original articles and brief reports. Study type (qualitative, quantitative), author (first and last), gender, and professional degree of the author (first and last) were recorded. Results: A total of 4881 articles were included in this study. The proportion of quantitative papers significantly increased across 3 time points from 63% to 67% to 78%. The proportion of women first authors increased across all 3 time points (54%, 2004-2008; 57%, 2009-2013; 60%, 2014-2018), and the proportion of women last authors increased across all time points (38%, 2004-2008; 44%, 2009-2013; 46%, 2014-2018). More than 40% of authors were physicians. Conclusions: Published PC studies are increasingly quantitative in design. Gender authorship is female dominant for the first authors and increasingly equal across genders for the last authors.

“Nothing More to Be Done”: Palliative Care Versus Exerimental Therapy in Advanced Cancer

1995 ◽  
Vol 8 (1) ◽  
pp. 209-229 ◽  
Author(s):  
Ilana Löwy
Keyword(s):  
United States ◽  
Palliative Care ◽  
United Kingdom ◽  
The United States ◽  
Experimental Therapy ◽  
Incurable Cancer ◽  
The United Kingdom ◽  
Experimental Therapies ◽  
The Difference ◽  
The Individual

The ArgumentPatients suffering from advanced, incurable cancer often receive from their doctors proposals to enroll in a clinical trial of an experimental therapy. Experimental therapies are increasingly perceived not as a highly problematic approach but as a near-standard way to deal with incurable cancer. There are, however, important differences in the diffusion of these therapies in Western countries. The large diffusion of experimental therapies for malignant disease in the United States contrasts with the much more restricted diffusion of these therapies in the United Kingdom. The difference between the two reflects differences in the organization of health care in these countries and distinct patterns of the professionalization of medical oncology in America and in Britain. The high density and great autonomy of medical oncologists in the United States encourages there the diffusion of experimental therapies (regarded by some as expensive and inefficient); the lower density of these specialists in the United Kingdom and their task as consultants and not primary caregivers, favors the choice of more conservative (for some, too conservative) treatments. Theoretically, the decision as to whether patients suffering from advanced, incurable cancer will be steered toward an experimental therapy or toward palliative care depends on the values and beliefs of these patients and their physicians. In practice, however, such choice does not depend exclusively on the individual' cultural background and ethical values, but is also strongly affected by the — culturally conditioned — Professional and institutional structure of medicine

The Impact of Contingency Fees on Collective Antitrust Actions: Experiments from Lithuania and Poland

2016 ◽  
Vol 41 (3-4) ◽  
pp. 368-395 ◽  
Author(s):  
Žygimantas Juška
Keyword(s):  
United States ◽  
European Union ◽  
Conflicts Of Interest ◽  
Group Actions ◽  
The United States ◽  
Individual Behavior ◽  
The European Union ◽  
Contingency Fees ◽  
The Individual ◽  
The Impact

Contingency-fee agreements are one—if not the only—tool that can be used to ensure that small-stakes collective antitrust actions are heard, yet they are subject to strong resistance from the European Union. There is a concern that contingency fees could lead to abuses of the system or conflicts of interest, as has been seen in the United States. Contrary to eu policy, two proactive member states—Lithuania and Poland—have introduced the possibility of using contingency fees in group litigation in order to facilitate group actions. Despite having a lot of potential, this paper will demonstrate that the introduction alone of contingency fees will not facilitate the compensation objective that is embedded in the Directive on damages actions. In addition, it will show that the safeguard policy against frivolous litigation is sufficient to limit the possibilities for litigation abuses, but it is ineffective for monitoring the individual behavior of group representatives.

Spirituality and the Care of Patients at the End-of-Life: An Essential Component of Care

2008 ◽  
Vol 56 (1) ◽  
pp. 33-46 ◽  
Author(s):  
Christina M. Puchalski
Keyword(s):  
United States ◽  
Palliative Care ◽  
Healthcare System ◽  
Spiritual Care ◽  
Healthcare Professionals ◽  
The United States ◽  
Evidence Base ◽  
Essential Component ◽  
Spiritual Issues ◽  
Hospice And Palliative Care

Spirituality is an essential component of the care of patients with serious illness and those that are dying. Dame Cicely Saunders developed the hospice movement based on the biopsychosocialspiritual model of care, in which all four dimensions are important in the care of patients. Of all the models of care, hospice and palliative care recognize the importance of spiritual issues in the care of patients and their families. The National Consensus Project Guidelines for Quality Palliative Care, in the United States, provides specific recommendations about all domains of care including the spiritual domain, which is recognized as a critical component of care (The National Consensus Project for Quality Palliative Care www.nationalconsensusproject.org ). Studies indicate that the majority of patients would like their spiritual issues addressed, yet find that their spiritual needs are not being met by the current system of care. Interestingly, spirituality is the one dimension that seems to get slightly less emphasis than the biopsychosocial dimensions of care. Some reasons may include the difficulty with definitions of spirituality for clinical and research purposes, the time constraints and financial burdens in the current healthcare system in the United States, and the lack of uniform training for all healthcare professionals. Yet, there are theoretical and ethical frameworks that support spiritual care as well as some educational models in spirituality and health that have been successful in medical education in the United States. Spirituality can be seen as the essential part of the humanity of all people. It is at its root, relational and thus forms the basis of the altruistic care healthcare professionals are committed to. Spirituality has to do with respecting the inherent value and dignity of all persons, regardless of their health status. It is the part of humans that seeks healing, particularly in the midst of suffering. Spiritual care models are based on an intrinsic aspect that calls for compassionate presence to patients as well as an extrinsic component where healthcare professionals address spiritual issues with patients and their loved ones. Currently in the healthcare system, evidence-base models are the criteria for practice recommendations. Yet, spirituality may not be amenable entirely to strict evidence-base criteria. As hospice and palliative care continues to develop as a field, healthcare professionals are challenged to think of ways to advocate for and include the spiritual dimension of care.

scholarly journals Routinization and Covid‑19: A Comparison Between the United States and Portugal

2020 ◽  
pp. 133-166
Author(s):  
Piero De Dominicis
Keyword(s):  
United States ◽  
Wage Inequality ◽  
The United States ◽  
Earnings Inequality ◽  
Current Crisis ◽  
Occupational Tasks ◽  
Wage Premia ◽  
The Individual ◽  
Earnings Dispersion ◽  
The Impact

The purpose of this study is to identify the role of automatization in increasing wage inequality, by comparing the United States to Portugal. Using the PSID and Quadros de Pessoal (Personnel Records), we find that labor income dynamics are strongly determined by the variance of the individual fixed component. This effect is drastically reduced by adding information on workers’ occupational tasks, confirming that a decreasing price of capital and the consequent replacement of routine manual workers have deepened wage inequality. During the current crisis, we find that the ability to keep working is strongly related with the kind of occupation. As such, we foster the impact of a permanent demand shock using an overlapping generations model with incomplete markets and heterogeneous agents to quantitatively predict the impact of Covid‑ 19 and lockdown measures on wage premium and earnings inequality. We find that wage premia and earnings dispersion increase, suggesting that earnings inequality will increase at the expense of manual workers.

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