The "dirty work" of last responders: Occupational stigma risk and protective factors.

Last responders constitute an occupational category that includes all those who are involved in the postmortem care of deceased persons and their families. The work of last responders is often considered "dirty work" and, as a result, stigmatized. Last responders are aware of this stigma, and stigma consciousness has been associated with negative health outcomes. Despite the wide acknowledgment of stigma among last responders, specific risk, or protective factors for experiencing stigma have not been investigated. This paper aims to identify determinants of stigma among last responders in the United States. The data for this study were obtained from a national cross-sectional survey of last responders. The survey included a measure of stigma and multiple sociodemographic characteristics. A hurdle model was used to assess the association between the characteristics of last responders and their perceived stigma. Respondents were predominantly male (55.1%), White non-Hispanic (90.2%), and employed full-time (96%). Seventy-seven percent reported having experienced at least one form of occupation-related stigma. There was no significant association between the experience of stigma and any socio-demographic variables. The experience of stigma is nearly ubiquitous among last responders->75% of last responders in the sample experienced at least one form of stigma. Another aspect of its ubiquitous nature is the lack of evidence that stigma was experienced differentially across sex, race/ethnicity, employment type, and length of years as a last responder. Interventions are needed to decrease stigma among last responders and to support last responders in managing the consequences of the stigma they experience.

Symptom evaluation in palliative medicine: patient report vs systematic assessment.

PURPOSE: This study examined symptoms reported by patients after open-ended questioning vs those systematically assessed using a 48-question survey. MATERIALS AND METHODS: Consecutive patients referred to the palliative medicine program at the Cleveland Clinic Foundation were screened. Open-ended questions were asked initially followed by a 48-item investigator-developed symptom checklist. Each symptom was rated for severity as mild, moderate, or severe. Symptom distress was also evaluated. Data were collected using standardized pre-printed forms. RESULTS: Two hundred and sixty-five patients were examined and 200 were eligible for assessment. Of those assessed, the median age was 65 years (range 17-90), and median ECOG performance status was 2 (range 1-4). A total of 2,397 symptoms were identified, 322 volunteered and 2,075 by systematic assessment. The median number of volunteered symptoms was one (range zero to six). Eighty-three percent of volunteered symptoms were moderate or severe and 17% mild. Ninety-one percent were distressing. Fatigue was the most common symptom identified by systematic assessment but pain was volunteered most often. The median number of symptoms found using systematic assessment was ten (0-25). Fifty-two percent were rated moderate or severe and 48% mild. Fifty-three percent were distressing. In total, 69% of 522 severe symptoms and 79% of 1,393 distressing symptoms were not volunteered. Certain symptoms were more likely to be volunteered; this was unaffected by age, gender, or race. CONCLUSION: The median number of symptoms found using systematic assessment was tenfold higher (p<0.001) than those volunteered. Specific detailed symptom inquiry is essential for optimal palliation in advanced disease.

Computed tomography angiography validates duplex sonographic evaluation of carotid artery stenosis.

Controversy regarding the optimal preoperative evaluation for patients with carotid arterial stenosis remains controversial. We hypothesized that carotid artery area reduction measured by computed tomography angiography (CTA) would closely correlate with duplex scanning stenosis. This study was undertaken to evaluate the correlation between duplex, CTA, and conventional arteriography in patients undergoing consideration for carotid endarterectomy. Patients undergoing evaluation for carotid artery stenosis who received at least 2 of the diagnostic tests were included in this study (n = 108); 30 patients underwent all 3 imaging modalities. Linear regression analysis was performed to determine correlation coefficients between the 3 different study modalities. Correlation and P values were as follows: CTA area versus CTA diameter, r = 0.82, P < 0.001; CTA area versus duplex stenosis, r = 0.71, P < 0.001; duplex stenosis versus angio diameter, r = 0.68; P = 0.005; CTA diameter versus angio diameter, r = 0.61, P = 005. CTA was able to identify plaque characteristics more readily than duplex or arteriography. CTA was also able to differentiate critical stenosis from occlusion and to settle discrepancies obtained from duplex scanning. CTA is an acceptable alternative method to validate duplex scanning evaluation of carotid artery stenosis. It can accurately measure lumen stenosis, visualize plaque morphology, and is associated with fewer complications than conventional angiography.