The growth of Health and Medical Humanities baccalaureate and master’s degrees in recent decades makes the present moment ideal for initiating field-defining conversations among health humanities constituents about the boundaries of this... more
The growth of Health and Medical Humanities baccalaureate and master’s degrees in recent decades makes the present moment ideal for initiating field-defining conversations among health humanities constituents about the boundaries of this transdisciplinary field. Focusing on accreditation at the programme level rather than the individual level, we explore four models with different advantages for Health and Medical Humanities: a certification for practice; a network (umbrella organisation); a programme of merit (POM) model; and consultancy. We conclude that for a young field like health humanities that is transdisciplinary, does not have an established canon and does not lead to entry to a specific professional path (ie, gatekeeping), the POM model is the best fit. In contrast to a full accreditation model, POM credentialling leaves room for creativity, expansiveness, and diversity of approaches and will not restrict programmes from calling themselves health humanities programmes; PO...
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Psychology and Routledge
PHENOMENON Assessment and evaluation guidelines inform programmatic changes necessary for educational effectiveness. Presently, no widely accepted guidelines exist for educators to assess learners and evaluate programs regarding social... more
PHENOMENON Assessment and evaluation guidelines inform programmatic changes necessary for educational effectiveness. Presently, no widely accepted guidelines exist for educators to assess learners and evaluate programs regarding social determinants of health (SDOH) during physician and physician assistant (PA) education. We sought to garner expert consensus about effective SDOH learner assessment and program evaluation, so as to make recommendations for best practices related to SDOH education. APPROACH We used a Delphi approach to conduct our study (September 2019 to December 2020). To administer our Delphi survey, we followed a three-step process: 1) literature review, 2) focus groups and semi-structured interviews, 3) question development and refinement. The final survey contained 72 items that addressed SDOH content areas, assessment methods, assessors, assessment integration, and program evaluation. Survey participants included 14 SDOH experts at US medical schools and PA programs. The survey was circulated for three rounds seeking consensus, and when respondents reached consensus on a particular question, that question was removed from subsequent rounds. FINDINGS The geographically diverse sample of experts reached consensus on many aspects of SDOH assessment and evaluation. The experts selected three important areas to assess learners' knowledge, skills, and attitudes about SDOH. They identified assessment methods that were "essential", "useful, but not essential", and "not necessary." The essential assessment methods are performance rating scales for knowledge and attitudes and skill-based assessments. They favored faculty and patients as assessors, as well as learner self-assessment, over assessments conducted by other health professionals. Questions about separation versus incorporation of SDOH assessment with other educational assessment did not yield consensus opinion. The experts reached consensus on priority outcome measures to evaluate a school's SDOH program which included student attitudes toward SDOH, Competence-Based Assessment Scales, and the percentage of graduates involved in health equity initiatives. INSIGHTS Based on the Delphi survey results, we make five recommendations that medical and PA educators can apply now when designing learner assessments and evaluating SDOH programming. These recommendations include what should be assessed, using what methods, who should do the assessments, and how they should be incorporated into the curriculum. This expert consensus should guide future development of an assessment and evaluation toolkit to optimize SDOH education and clinical practice. Supplemental data for this article is available online at https://doi.org/10.1080/10401334.2022.2045490 .
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Objectives: The aim of this study was to carry out a preliminary trial evaluating the effectiveness of home-opathy in the treatment of attention-deficit/hyperactivity disorder (ADHD). Design: This work was a randomized, double-blind,... more
Objectives: The aim of this study was to carry out a preliminary trial evaluating the effectiveness of home-opathy in the treatment of attention-deficit/hyperactivity disorder (ADHD). Design: This work was a randomized, double-blind, placebo-controlled trial. Settings/Location: This study was conducted in a private homeopathic clinic in the Seattle metropolitan area. Subjects: Subjects included children 6–12 years of age meeting Diagnostic and Statistical Manual of Men-tal Disorders 4th edition (DSM-IV) criteria for ADHD. Interventions: Forty-three subjects were randomized to receive a homeopathic consultation and either an in-dividualized homeopathic remedy or placebo. Patients were seen by homeopathic physicians every 6 weeks for 18 weeks.
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The growth of Health and Medical Humanities baccalaureate and master’s degrees in recent decades makes the present moment ideal for initiating field-defining conversations among health humanities constituents about the boundaries of this... more
The growth of Health and Medical Humanities baccalaureate and master’s degrees in recent decades makes the present moment ideal for initiating field-defining conversations among health humanities constituents about the boundaries of this transdisciplinary field. Focusing on accreditation at the programme level rather than the individual level, we explore four models with different advantages for Health and Medical Humanities: a certification for practice; a network (umbrella organisation); a programme of merit (POM) model; and consultancy. We conclude that for a young field like health humanities that is transdisciplinary, does not have an established canon and does not lead to entry to a specific professional path (ie, gatekeeping), the POM model is the best fit. In contrast to a full accreditation model, POM credentialling leaves room for creativity, expansiveness, and diversity of approaches and will not restrict programmes from calling themselves health humanities programmes; PO...
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Preliminary studies investigating yoga and breath work for treating asthma have been promising. Several randomized controlled trials have shown a benefit from yoga postures and breathing vs control, but the control in these cases involved... more
Preliminary studies investigating yoga and breath work for treating asthma have been promising. Several randomized controlled trials have shown a benefit from yoga postures and breathing vs control, but the control in these cases involved no intervention other than usual care. This study advances the field by providing an active control. To determine the effectiveness and feasibility of a yoga and breath work intervention for improving clinical indices and quality of life in adults with mild-to-moderate asthma. A randomized, controlled, double-masked clinical trial was conducted between October 1, 2001, and March 31, 2003. Random assignment was made to either a 4-week yoga intervention that included postures and breath work or a stretching control condition. Outcome measures were evaluated at 4, 8, 12, and 16 weeks and included the Mini Asthma Quality of Life Questionnaire, rescue inhaler use, spirometry, symptom diaries, and health care utilization. Sixty-two participants were randomized to the intervention and control groups, and 45 completed the final follow-up measures. Intention-to-treat analysis was performed. Significant within-group differences in postbronchodilator forced expiratory volume in 1 second and morning symptom scores were apparent in both groups at 4 and 16 weeks; however, no significant differences between groups were observed on any outcome measures. Iyengar yoga conferred no appreciable benefit in mild-to-moderate asthma. Circumstances under which yoga is of benefit in asthma management, if any, remain to be determined.
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Immunology, Yoga, Quality of life, Asthma, Medicine, and 12 moreSport, Humans, Female, Feasibility Studies, Male, Aged, Middle Aged, Pilot study, Questionnaires, Adult, Elsevier, and Pilot Projects
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BACKGROUND There is widespread concern regarding the adequacy of evidence for specific practices under the rubric of "complementary and alternative medicine" (CAM). OBJECTIVE To map the evidence pertaining to many commonly used... more
BACKGROUND There is widespread concern regarding the adequacy of evidence for specific practices under the rubric of "complementary and alternative medicine" (CAM). OBJECTIVE To map the evidence pertaining to many commonly used CAM practices. DESIGN In 2000, the Yale Prevention Research Center was funded by the Centers for Disease Control and Prevention to conduct a "systematic review" of the evidence underlying CAM. The investigative team, working in collaboration with CAM practitioners, developed a systematic and replicable 9-step process termed evidence mapping. The process stipulates means for specifying the boundaries of the subject to be mapped in MeSH terms, and the characteristics used to situate retrieved articles in the overall map of evidence. SETTING Yale Prevention Research Center, Derby, CT. RESULTS Steps completed thus far have led to the identification of over 4,000 papers distributed across 207 condition-treatment pairs. Of these pairs, 58% (n = ...
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As cancer in the USA transitions to a disease trajectory similar to other chronic illnesses, care has moved to outpatient settings where patients and their families are responsible for day-to-day management and treatment-related side... more
As cancer in the USA transitions to a disease trajectory similar to other chronic illnesses, care has moved to outpatient settings where patients and their families are responsible for day-to-day management and treatment-related side effects [1]. The family member or friend who assumes the role of caregiver has little opportunity to acclimate to their new responsibilities, personal response to the diagnosis, or the healthcare system [2]. The caregiver’s focus and the primary focus of treatment is the patient [3, 4]. Our understanding of cancer family caregivers’ needs and consequences has grown in recent years as more research has been directed toward this population [5, 6]. The physical and psychological impact of cancer family caregiving is significant with many associated negative outcomes including depression, anxiety, decreased quality of life, fatigue, sleep disturbance, pain, and decline in health status [7–10]. In some studies, cancer family caregivers were found to have wor...
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Depression, Adolescent, Multivariate Analysis, Humans, Female, and 14 moreMale, Young Adult, Caregivers, Ethnic Groups, African Americans, Aged, Middle Aged, Adult, European Continental Ancestry Group, Antineoplastic Agents, Psychology and Cognitive Sciences, Medical and Health Sciences, Colonic Neoplasms, and lung neoplasms
Photo by Sam McGhee on Unsplash ABSTRACT Medical education has a long history of discriminatory practices. Because of the hierarchy inherent in medical education, underrepresented-in-medicine (URiM) students are particularly vulnerable to... more
Photo by Sam McGhee on Unsplash ABSTRACT Medical education has a long history of discriminatory practices. Because of the hierarchy inherent in medical education, underrepresented-in-medicine (URiM) students are particularly vulnerable to discrimination and often feel they have limited recourse to respond without repercussions. URiM student leaders at a USA medical school needed their peers, faculty, and administration to know the institutional racism and other forms of discrimination they regularly experienced. The students wanted to share first-person narratives of their experiences; however, they feared retribution. This paper describes how the medical students partnered with a theater company that applied elements of verbatim theater to anonymously present student narratives and engage their medical school community around issues of racism and discrimination. The post-presentation survey showed the preponderance of respondents increased understanding of URiM student experiences,...
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A person living with cancer will potentially have some degree of physical, cognitive, and/or psychological impairment, periods of unemployment, financial concerns, social isolation, and existential questions, any or all of which can... more
A person living with cancer will potentially have some degree of physical, cognitive, and/or psychological impairment, periods of unemployment, financial concerns, social isolation, and existential questions, any or all of which can impact the family and friends who surround them. In our current era of health care, patients with cancer receive invasive diagnostic studies and aggressive treatment as outpatients, and then convalesce at home. As such, cancer family caregivers are de facto partners with the healthcare team. The cancer family caregiver role is demanding and may lead to increased morbidity and mortality-in effect, the cancer family caregiver can become a second patient in need of care. This chapter discusses the consequences cancer family caregivers may accrue. The topics covered include caregiver mood disturbance and psychological impairment and some of the mutable factors that contribute to these states (i.e., sleep disturbance, decline in physical health, restriction o...
Research shows that spiritual well-being correlates positively with quality of life (QOL) for people with cancer, whereas contradictory findings are frequently reported with respect to the differentiated associations between dimensions of... more
Research shows that spiritual well-being correlates positively with quality of life (QOL) for people with cancer, whereas contradictory findings are frequently reported with respect to the differentiated associations between dimensions of spiritual well-being, namely peace, meaning and faith, and QOL. This study aimed to examine individual patterns of spiritual well-being among patients newly diagnosed with advanced cancer. Cluster analysis was based on the twelve items of the 12-item Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale at Time 1. A combination of hierarchical and k-means (non-hierarchical) clustering methods was employed to jointly determine the number of clusters. Self-rated health, depressive symptoms, peace, meaning and faith, and overall QOL were compared at Time 1 and Time 2. Hierarchical and k-means clustering methods both suggested four clusters. Comparison of the four clusters supported statistically significant and clinically meaning...
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To assess the evidence evaluating S-adenosylmethionine (SAMe) supplementation as treatment for depression. Searches of Medline, Psychinfo, AMED, and Cochrane Controlled Trials Register were conducted from database inception through... more
To assess the evidence evaluating S-adenosylmethionine (SAMe) supplementation as treatment for depression. Searches of Medline, Psychinfo, AMED, and Cochrane Controlled Trials Register were conducted from database inception through September 2001. Randomized controlled trials, controlled clinical trials, intervention studies, case-control studies, reviews, and case reports examining the evidence behind S-adenosylmethionine (SAMe) supplementation in depression among humans were selected. No limits were placed on study populations for demographics or co-morbidities. Only English language papers were abstracted and assessed for trial quality. Two abstractors independently evaluated each study, and then reconciled findings. As data were available, between group treatment effect size was noted or, as needed, calculated. Eleven articles met initial inclusion criteria; five intervention trials, two RCTs, two reviews, one controlled clinical trial, and one meta-analysis. Using the one commo...
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Purpose To understand family caregivers' needs for better preparation and care, this state-of-the-science review examines the effect of caregiving on the health and well-being of caregivers, the efficacy of research-tested... more
Purpose To understand family caregivers' needs for better preparation and care, this state-of-the-science review examines the effect of caregiving on the health and well-being of caregivers, the efficacy of research-tested interventions on patient and caregiver outcomes, implications of the research on policy and practice, and recommendations for practice and future research. Methods We reviewed research that described the multiple effects of cancer on caregivers' well-being. Five meta-analyses were analyzed to determine the effect of interventions with caregivers on patient and caregiver outcomes. In addition, we reviewed legislation such as the Affordable Care Act and the Family Leave Act along with current primary care practice to determine whether family caregivers' needs have been addressed. Results Research findings indicate that caregiver stress can lead to psychological and sleep disturbances and changes in caregivers' physical health, immune function, and fi...
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Purpose To understand family caregivers' needs for better preparation and care, this state-of-the-science review examines the effect of caregiving on the health and well-being of caregivers, the efficacy of research-tested... more
Purpose To understand family caregivers' needs for better preparation and care, this state-of-the-science review examines the effect of caregiving on the health and well-being of caregivers, the efficacy of research-tested interventions on patient and caregiver outcomes, implications of the research on policy and practice, and recommendations for practice and future research. Methods We reviewed research that described the multiple effects of cancer on caregivers' well-being. Five meta-analyses were analyzed to determine the effect of interventions with caregivers on patient and caregiver outcomes. In addition, we reviewed legislation such as the Affordable Care Act and the Family Leave Act along with current primary care practice to determine whether family caregivers' needs have been addressed. Results Research findings indicate that caregiver stress can lead to psychological and sleep disturbances and changes in caregivers' physical health, immune function, and fi...
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Thesis (M.P.H.)--Southern Connecticut State University, 1996. Includes bibliographical references (leaves 69-76).
Because caregiving to an adult with cancer is a dynamic process, a caregiver's perceived burden and psychosocial concerns may be different at different phases of the patient's disease. There is evidence of escalation in caregiver... more
Because caregiving to an adult with cancer is a dynamic process, a caregiver's perceived burden and psychosocial concerns may be different at different phases of the patient's disease. There is evidence of escalation in caregiver anxiety, depression, and psychological distress as the patient's functional status declines and as the patient nears death. The purpose of this review was to organize the literature in a meaningful way that can potentially capture the unique needs of caregivers to patients receiving palliative and/or hospice care, and caregivers who are in the post-death bereavement phase. A systematic review was conducted. Major databases were searched for non-intervention descriptive studies that included psychosocial variables of family caregivers to adults with cancer during the palliative, hospice, or bereavement phases. The 19 studies reviewed were conducted in six countries and varied considerably by samples, outcome measures, methodologies, and analytic ...
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Nursing, Psychometrics, Cancer, Quality of life, Cultural Diversity, and 16 moreHumans, United States, Female, Cancer Nursing, Male, Young Adult, Caregivers, Ethnic Groups, African Americans, Middle Aged, Psychological Tests, Questionnaires, Adult, Public health systems and services research, Neoplasms, and European Continental Ancestry Group
Background Meditation health benefits have been difficult to document, as many efficacy studies are marred by lack of statistical power secondary to small sample size and/or threats to validity from high attrition. To date, no published... more
Background Meditation health benefits have been difficult to document, as many efficacy studies are marred by lack of statistical power secondary to small sample size and/or threats to validity from high attrition. To date, no published studies have examined barriers to meditation that are likely responsible for low enrollment and high attrition. Objective To develop an instrument to capture barriers to meditation use, namely, the Determinants of Meditation Practice Inventory (DMPI). Design A five-step, mixed-methods approach was used, including literature review, qualitative interviews, content validation, reliability testing, and construct validation. Participants/Setting Four distinct participant groups contributed. Four meditation teachers participated in qualitative interviews. Five expert panelists conducted the content validation. Ten nonmeditators participated in the pilot test. For reliability testing and construct validation, 150 cancer family caregivers participated. Outc...
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Prevalence estimates for clinical depression among cancer family caregivers (CFC) range upwards to 39%. Research inconsistently reports risk for CFC depressive symptoms when evaluating age, gender, ethnicity, or length of time as... more
Prevalence estimates for clinical depression among cancer family caregivers (CFC) range upwards to 39%. Research inconsistently reports risk for CFC depressive symptoms when evaluating age, gender, ethnicity, or length of time as caregiver. The discrepant findings, coupled with emerging literature indicating religiosity may mitigate depression in some populations, led us to investigate religion-related variables to help predict CFC depressive symptoms. We conducted a cross-sectional study of 150 CFC. Explanatory variables included age, gender, spousal status, length of time as caregiver, attendance at religious services, and prayer. The outcome variable was the Center for Epidemiological Studies Depression Scale score. Compared with large national and state datasets, our sample has lower representation of individuals with no religious affiliation (10.7% vs. 16.1% national, p = 0.07 and 23.0% state, p = 0.001), higher rate of attendance at religious services (81.3% vs. 67.2% national, p < 0.001 and 30.0% state, p < 0.001), and higher rate of prayer (65.3% vs. 42.9% national, p < 0.001; no state data available). In unadjusted and adjusted models, prayer is not significantly associated with caregiver depressive symptoms or clinically significant depressive symptomology. Attendance at religious services is associated with depressive symptoms (p = 0.004) with an inversely linear trend (p = 0.002). The significant inverse association between attendance at religious services and depressive symptoms, despite no association between prayer and depressive symptoms, indicates that social or other factors may accompany attendance at religious services and contribute to the association. Clinicians can consider supporting a CFC's attendance at religious services as a potential preventive measure for depressive symptoms. Copyright © 2014 John Wiley & Sons, Ltd.
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Descriptive studies of cancer family caregivers demonstrate role-related psychosocial and physical burden; however, little is known about which factors contribute to or obviate burden. Systematic reviews of caregiver intervention studies... more
Descriptive studies of cancer family caregivers demonstrate role-related psychosocial and physical burden; however, little is known about which factors contribute to or obviate burden. Systematic reviews of caregiver intervention studies demonstrate mixed results, perhaps because some caregiver needs are still unknown and not adequately addressed. The purpose of our study was to explore the lived experience of being a caregiver for an adult with lung or colon cancer, so as to guide the development of future intervention studies. Using phenomenologic methods, open-ended interviews were conducted at a chemotherapy clinic, New Haven, CT with 135 caregivers to adults with lung or colon cancer. Interviews were audio-recorded and transcribed. Thematic analysis was conducted with transcripts coded, reviewed, and recoded multiple times. The final 69 codes were reduced to 13 code clusters (thematic categories) distributed among 4 themes. Four inter-related themes emerged: 1) becoming a caregiver; 2) new and altered relationships; 3) personal responses to caregiving and 4) antecedents and social context. Caregivers describe hearing the cancer diagnosis as "life-changing". The cancer creates the context for the caregiver's relationships (with the patient, self, others, and the healthcare system), and cognitive, behavioral, affective, and spiritual responses. The caregiver's antecedent experiences and social support network form the foundation for their perceptions of the diagnosis, relationships, and personal responses. This study implicates several intervention components to be developed and tested as favorably supporting caregivers, namely, reinforcing positive aspects of caregiving, cultivating open communication, and acknowledging the prior experiences and social foundation of the caregiver's life that can be supportive or burdensome.
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Nursing, Quality of life, Palliative Medicine, Massage, Meditation, and 13 moreHumans, Female, Male, Clinical Sciences, Middle Aged, Pilot study, Adult, Public health systems and services research, Analysis of Variance, Randomized Controlled Trial, Palliative, Pilot Projects, and Acquired immunodeficiency syndrome
Journal of Hospice & Palliative Nursing. Wolters Kluwer Health Logo. All Issues. ...
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Research Design, Attention-Deficit/Hyperactivity Disorder, Complementary and Alternative Medicine, Homeopathy, Treatment Outcome, and 17 moreAdolescent, Child Behavior, Humans, Child, Female, Male, Alternative, Statistical Significance, Complementary and Alternative Medicine in the Health Service, Rating Scale, Pilot study, Analysis of Variance, Randomized Controlled Trial, Materia Medica, Indexation, Pilot Projects, and Control Group
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We examined the risk for depressive symptoms associated with age, education, ethnicity, gender, marital status, apolipoprotein E genotype (APOE) and memory complaints among non-demented elderly (≥60 years). ... Cross-sectional study of... more
We examined the risk for depressive symptoms associated with age, education, ethnicity, gender, marital status, apolipoprotein E genotype (APOE) and memory complaints among non-demented elderly (≥60 years). ... Cross-sectional study of geriatric patients recruited ...
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Major depression is the leading cause of disability worldwide, and among the 10 most frequent indications for using alternative medicine therapies, especially dietary supplements. To assess the evidence evaluating vitamin B-6... more
Major depression is the leading cause of disability worldwide, and among the 10 most frequent indications for using alternative medicine therapies, especially dietary supplements. To assess the evidence evaluating vitamin B-6 supplementation as treatment for depression. Medline, Psychinfo, AMED, and Cochrane Controlled Trials Register were searched from database inception through September 2001. All randomized controlled trials, controlled clinical trials, intervention studies, case-control studies, reviews, and case reports examining the evidence behind vitamin B-6 in depression among humans were selected. No limits were placed for demographics or co-morbidities. Only English language papers were abstracted and assessed for trial quality. Two abstractors independently evaluated each study, then reconciled findings. As data were available, between group treatment effect size was noted or, as needed, calculated. When studies reported outcome effects using multiple measures, data were abstracted to permit the greatest possible comparisons among papers. Ten articles met inclusion criteria; three reviews, one case report, five RCTs, and one intervention study. There was no common outcome measure among all studies, eliminating opportunity for direct comparison of effect sizes. As an alternate means of comparison, effects were plotted as they related to the null hypothesis. Viewed as a whole, meaningful treatment effect of vitamin B-6 for depression in general was not apparent. However, examination of papers addressing depression in pre-menopausal women only, reveals a consistent message about the value of using vitamin B-6 supplementation. Further study of vitamin B-6 as independent and adjuvant therapy for hormone related depression in women is indicated.
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Depression, English language, Family, Family Practice, Case Report, and 11 moreHumans, Effect size, Complementary Therapies, Alternative Medicine, Systematic review, Public health systems and services research, Intervention study, English Language, Dietary Supplement, ADJUVANT THERAPY, and Treatment Effect
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... Gaithersburg, MD: Aspen Publishers. Selwyn, PA, & Arnold, R. (1998). From fate to tragedy: The changing meanings of life, death, and AIDS. Annals of Internal Medicine, 129, 899-902. Selwyn, PA, Goulet, J., Molde, S., Constantino,... more
... Gaithersburg, MD: Aspen Publishers. Selwyn, PA, & Arnold, R. (1998). From fate to tragedy: The changing meanings of life, death, and AIDS. Annals of Internal Medicine, 129, 899-902. Selwyn, PA, Goulet, J., Molde, S., Constantino, J., Fennie, K., Wetherill, P., et al. (2000). ...