Geographic reinforcement of the incest taboo: three case vignettes

This article details the experience of two South Asian individuals with family members who had communication disorders. I provide information on intrinsic and extrinsic barriers reported by these clients in responses to a survey and during individual ethnographic interviews. These data are part of a larger study and provide empirical support of cultural and linguistic barriers that may impede timely access to and utilization of speech-language pathology (SLP) services. The purpose of this article is to shed light on barriers and facilitators that influence South Asian clients' access to SLP services. I provide and briefly analyze two case vignettes to provide readers a phenomenological perspective on client experiences. Data about barriers limiting access to SLP services were obtained via client surveys and individual interviews. These two clients' data were extracted from a larger study (Mahendra, Scullion, Hamerschlag, Cooper, & La, 2011) in which 52 racially/ethnically diverse clients participated. Survey items and interview questions were designed to elicit information about client experiences when accessing SLP services. Results reveal specific intrinsic and extrinsic barriers that affected two South Asian clients' access to SLP services and have important implications for all providers.

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An introduction to advance care planning: practice at the frontline

10.1093/oso/9780198802136.003.0003 ◽

2018 ◽

Author(s):

Anjali Mullick ◽

Jonathan Martin

Keyword(s):

Decision Making ◽

Clinical Practice ◽

Communication Skills ◽

Advance Care Planning ◽

Use Case ◽

Care Planning ◽

Practical Advice ◽

Future Care ◽

Case Vignettes ◽

Advance Care

Advance care planning (ACP) is a process of formal decision-making that aims to help patients establish decisions about future care that take effect when they lose capacity. In our experience, guidance for clinicians rarely provides detailed practical advice on how it can be successfully carried out in a clinical setting. This may create a barrier to ACP discussions which might otherwise benefit patients, families and professionals. The focus of this paper is on sharing our experience of ACP as clinicians and offering practical tips on elements of ACP, such as triggers for conversations, communication skills, and highlighting the formal aspects that are potentially involved. We use case vignettes to better illustrate the application of ACP in clinical practice.

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Disenchantment, Buffering, and Spiritual Reductionism: A Pedagogy of Secularism for Counseling and Psychotherapy

Religions ◽

10.3390/rel12080612 ◽

2021 ◽

Vol 12 (8) ◽

pp. 612

Author(s):

Waleed Y. Sami ◽

John Mitchell Waters ◽

Amelia Liadis ◽

Aliza Lambert ◽

Abigail H. Conley

Keyword(s):

Mental Health ◽

Social Work ◽

Counseling Psychology ◽

Formal Education ◽

Contemporary Society ◽

Religion And Spirituality ◽

Case Vignettes

The various mental health disciplines (e.g., counseling, psychology, social work) all mandate competence in working with clients from diverse religious and spiritual backgrounds. However, there is growing evidence that practitioners feel ill-equipped to meet the needs of their religiously- and spiritually-diverse clients. Furthermore, formal education on religion and spirituality remains optional within coursework. Research on religion and spirituality is also noted for its reductionism to observable outcomes, leaving much of its nuance uncovered. This paper will utilize philosophies of secularism and explore the concepts of disenchantment, buffering, and coercion, to help illuminate why our contemporary society and our disciplines struggle with this incongruence between stated values and implementation. Case vignettes and recommendations will be provided to help practitioners and educators.

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How do specialist surgeons treat the atrophic tooth gap? A vignette-based study among maxillofacial and oral surgeons

BMC Oral Health ◽

10.1186/s12903-021-01688-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Michael Korsch ◽

Winfried Walther ◽

Bernt-Peter Robra ◽

Aynur Sahin ◽

Matthias Hannig ◽

...

Keyword(s):

Decision Making ◽

Treatment Decision ◽

Bisphosphonate Therapy ◽

Bone Block ◽

Patient Anxiety ◽

Patient Age ◽

Endocarditis Prophylaxis ◽

Therapy Decision ◽

Patient Âgé ◽

Case Vignettes

Abstract Background There is little information available regarding the decision-making process of clinicians, especially in the choice of therapy for a severely atrophic tooth gap. The aim of this research was to use case vignettes to determine the influence of possible factors on the decision making of maxillofacial and oral surgeons. Methods A total of 250 maxillofacial (MFS) and oral (OS) surgeons in southern Germany were surveyed for atrophic single- or multiple-tooth gap with the help of case vignettes. The influence of different determinants on the therapy decision was investigated. Two case vignettes were designed for this purpose: vignette 1 with determinants “patient age” and “endocarditis prophylaxis” and vignette 2 with determinants “anxiety” and “bisphosphonate therapy”. Furthermore, the specialist designation was assessed for both. The options available to achieve a sufficient implant site were "bone split", "bone block", "augmentation with bone substitute material" and "bone resection". Therapy was either recommended or rejected based on principle. Results A total of 117 participants returned the questionnaire: 68 (58%) were OS and 49 (42%) MFS. “Patient age” and “patient anxiety” were not significantly associated with any therapy decision. However, required “endocarditis prophylaxis” led to significantly higher refusal rates for "bone split", "bone block" and "bone replacement material" and to higher rates of general refusal of a therapy. “Bisphosphonate therapy” was significantly associated with general refusal of therapy, but with no significant correlation with different therapy options. In vignette 1, OS refused therapy significantly more often than MFS, though there was no association with the specialist designation for other therapy modalities. In vignette 2, specialty was not significantly associated with the therapy decision. Conclusion “Patient age” as well as “patient anxiety” appear to have no or little influence on the treatment decision for severely atrophic single- or multiple-tooth gap by specialist surgeons. Surgeons more often refuse treatment for patients with endocarditis prophylaxis and bisphosphonate therapy.

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Evaluation of Antibiotic Supply Decisions by Community Pharmacists in Thailand: A Vignette Study

Antibiotics ◽

10.3390/antibiotics10020154 ◽

2021 ◽

Vol 10 (2) ◽

pp. 154

Author(s):

Sisira Donsamak ◽

Marjorie C. Weiss ◽

Dai N. John

Keyword(s):

Respiratory Infections ◽

Acute Diarrhoea ◽

Community Pharmacists ◽

Antibiotic Use ◽

Educational Interventions ◽

Community Pharmacies ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Case Vignettes ◽

A Chain

In Thailand, antibiotics are available lawfully from community pharmacies without a prescription. Inappropriate supply of antibiotics from Thai community pharmacies to the public for common, self-limiting diseases has been reported. The study aimed to evaluate the appropriateness of antibiotics selected by community pharmacists in Thailand in response to vignettes. A cross-sectional survey of community pharmacists across Thailand was conducted using a self-administered questionnaire including nine case vignettes with three conditions, namely upper respiratory infections (URIs), acute diarrhoea and simple wounds. A total of 208 questionnaires were completed and analysed (20.8% response rate). In response to vignettes relating to URIs, 50.8% of pharmacist recommendations were not in accordance with antibiotic guidelines. Inappropriate recommendations for diarrhoea and wound cases were 20.8% and 16.7%, respectively. A higher proportion of younger pharmacists, those with less experience, Pharm. D. graduate pharmacists, employee pharmacists and those pharmacists who worked in a chain pharmacy were more likely to recommend appropriate antibiotic treatment in response to the vignettes (p < 0.05). These findings will be useful to promote educational interventions for community pharmacists regarding common infectious disease management in order to improve appropriate antibiotic use.

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O19 Easy-BILAG: a new tool for simplified recording of SLE disease activity using BILAG-2004

Rheumatology ◽

10.1093/rheumatology/keab246.018 ◽

2021 ◽

Vol 60 (Supplement_1) ◽

Author(s):

Lucy M Carter ◽

Caroline Gordon ◽

Chee-Seng Yee ◽

Ian Bruce ◽

David A Isenberg ◽

...

Keyword(s):

Clinical Care ◽

Coding System ◽

Scoring Method ◽

Highly Active ◽

Main Page ◽

Logical Sequence ◽

Case Vignettes ◽

Screening Questions ◽

Frequent Items ◽

Final Score

Abstract Background/Aims BILAG-2004 index is required to prescribe and monitor biologics in SLE. It is more comprehensive and responsive than the SLEDAI and widely used in clinical trials. However, it may be time-consuming and does require training for accurate use. The original format requires a separate index form, glossary and scoring algorithm. Further, the eventual scores from A (highly active) to E (no disease involvement) which are required to make treatment decisions, can be difficult to calculate during in routine clinical practice.The Easy-BILAG project aimed to develop and validate a simplified tool to score the original BILAG-2004 index more rapidly and with fewer errors, for use in routine clinical care. Methods The BILAG group identified four areas to address: (i) many items must be scored, but most are rare; (ii) glossary definitions are not always followed; (iii) the final score is not easily calculated at the time of assessment; (iv) training is time-consuming. Data from the BILAG-Biologics Registry were used to measure the frequency of each of 97 BILAG-2004 items in an active SLE population. These data and a series of prototypes were used to design a new tool for simplified scoring of the BILAG-2004 index - the “Easy-BILAG”. This instrument content was tested using exemplar paper cases. A validation study was then designed to test the Easy-BILAG compared to the standard BILAG-2004 scoring method for completion time and accuracy. Results 2395 assessments from the BILAG-BR were analysed. There was marked variation in item frequency. The 7 most frequent items were each present in more than 20% of records: arthralgia (72%), mild skin eruption (47%), moderate arthritis (38%), mild mucosal ulceration (34%), mild alopecia (34%), pleurisy / pericarditis (22%). 16 more items were scored in 5-20% of assessments; 36 items in 1-5% of assessments, and 25 items in < 1% of assessments. The Easy-BILAG was designed to capture items scoring >5% in a rapid single-page assessment. Items are arranged in a logical sequence of clinical assessment. An abridged glossary definition is cited immediately adjacent to each item. A new colour-coding system directs clinicians instantly to the overall A-E score for each domain (colour-blindness compatible). This single page assessment covered 68% of all assessments of biologic-treated patients. The remaining items are scored on a back page only in cases where necessary, as indicated by screening questions on the main page. The overall accuracy and usability of the Easy-BILAG template is now undergoing a validation against test series of standardized case vignettes by a sample of consultants and specialty trainees with a range of experience across England and Wales. Conclusion Easy-BILAG allows rapid scoring of BILAG-2004 in routine clinical practice. Following completion of validation, it will be made widely available to clinicians. Disclosure L.M. Carter: None. C. Gordon: None. C. Yee: None. I. Bruce: None. D.A. Isenberg: None. S. Skeoch: None. E.M. Vital: None.

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Trends in Brachial Plexus Surgery: Characterizing Contemporary Practices for Exploration of Supraclavicular Plexus

Hand ◽

10.1177/15589447211014613 ◽

2021 ◽

pp. 155894472110146

Author(s):

J. Ryan Hill ◽

Steven T. Lanier ◽

Liz Rolf ◽

Aimee S. James ◽

David M. Brogan ◽

...

Keyword(s):

Brachial Plexus ◽

Treatment Strategies ◽

Technical Difficulty ◽

Nerve Grafting ◽

Structured Interviews ◽

Lower Trunk ◽

Nerve Transfers ◽

Case Vignettes ◽

Distal Nerve

Background There is variability in treatment strategies for patients with brachial plexus injury (BPI). We used qualitative research methods to better understand surgeons’ rationale for treatment approaches. We hypothesized that distal nerve transfers would be preferred over exploration and nerve grafting of the brachial plexus. Methods We conducted semi-structured interviews with BPI surgeons to discuss 3 case vignettes: pan-plexus injury, upper trunk injury, and lower trunk injury. The interview guide included questions regarding overall treatment strategy, indications and utility of brachial plexus exploration, and the role of nerve grafting and/or nerve transfers. Interview transcripts were coded by 2 researchers. We performed inductive thematic analysis to collate these codes into themes, focusing on the role of brachial plexus exploration in the treatment of BPI. Results Most surgeons routinely explore the supraclavicular brachial plexus in situations of pan-plexus and upper trunk injuries. Reasons to explore included the importance of obtaining a definitive root level diagnosis, perceived availability of donor nerve roots, timing of anticipated recovery, plans for distal reconstruction, and the potential for neurolysis. Very few explore lower trunk injuries, citing concern with technical difficulty and unfavorable risk-benefit profile. Conclusions Our analysis suggests that supraclavicular exploration remains a foundational component of surgical management of BPI, despite increasing utilization of distal nerve transfers. Availability of abundant donor axons and establishing an accurate diagnosis were cited as primary reasons in support of exploration. This analysis of surgeon interviews characterizes contemporary practices regarding the role of brachial plexus exploration in the treatment of BPI.

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Vocation as Autobiography: Family of Origin Influences on the Caregiving Role in Ministry

Journal of Pastoral Care ◽

10.1177/002234099404800407 ◽

1994 ◽

Vol 48 (4) ◽

pp. 370-380 ◽

Cited By ~ 1

Author(s):

Frank J. Stalfa

Keyword(s):

Professional Development ◽

Systems Theory ◽

Family Systems ◽

Family Life ◽

Family Of Origin ◽

Family Systems Theory ◽

Therapeutic Applications ◽

Case Vignettes ◽

And Function

Presents an overview of transgenerational family systems theory with primary emphasis on the dynamics of family life which are understood to influence the decision to enter a helping profession. Evaluates the role of caregiver as an aspect of ministerial identity and function in order to ascertain those factors which enhance or undermine professional development. Illustrates these influences with case vignettes and suggests education and therapeutic applications.

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