Subthalamic Nucleus Deep Brain Stimulation in Parkinson's Disease: Valuable Programming Insights from Anecdotal Observations.

In this article, we use a case to illustrate and discuss some practically important learning points about programming subthalamic nucleus deep brain stimulation for Parkinson's disease patients and highlight clinically relevant issues resulting from anatomical and device-related anomalies. These include the phenomenon of a dominant subthalamic nucleus, clinical variability with delayed response to stimulation, equivalence of electrical charge when using short-pulse settings, and issues regarding conversion of settings between constant-current and constant-voltage devices that are increasingly common with the use of device components from multiple manufacturers.

Science Is Just Another Opinion: Making Medical Stories Count Post-COVID-19.

Science is facing a turbulent backlash in which it is often viewed as "just another opinion" among many competing unscientifically backed anecdotes. In these unprecedented times of the COVID-19 pandemic, when guidance from public health epidemiologists and administrators is critical, it is incumbent on all of us to consider how we can use data to tell emotionally compelling stories aimed at improving public health. When informing the public about COVID-19 and other pressing public health issues, the author argues that we must begin with emotionally captivating stories, grounded in science. Supporting this approach is the work of psychologist Paul Slovic, who has shown that human beings are not only hard-wired to be story-driven, but that we are not, in general, moved by data. The challenge, then, is to tell emotionally captivating stories supported by data, especially in these divisive times.

The Effect of Bullying Vignettes on Negative Affect.

The purpose of this study was to examine the influence of reading workplace bullying vignettes on negative affect. A within-subjects descriptive design and convenience sample was used. Fifty participants completed the Negative Affect Scale after reading written bullying vignettes and completed the Transportation Narrative questionnaire. Results provide evidence that the participants were transported into the vignettes. Additionally, descriptive statistics and a repeated measure ANOVA revealed a significant increase in negative affect over time. Written vignettes can provide a means to better understand how workplace events can impact cognitive performance. Practical and theoretical implications are discussed.

Pediatric Cancer Patients' Treatment Journey: Child, Adolescent, and Young Adult Cancer Narratives.

PURPOSE: The National Cancer Institute has acknowledged that for children, adolescents and young adults (AYAs), cancer is a leading cause of disability and death. This population has unique needs and until we fully understand those needs, we will not be able to provide optimal care. The purpose of this study was to understand the self-reported experience of cancer according to children and AYAs. DESIGN AND METHODS: A qualitative descriptive design was used. After obtaining IRB approval, participants were interviewed in Spanish or English. Thirty interviews were conducted with children and AYAs ages 10-22. Questions were asked about the patient's treatment journey and the impact on their lifestyle. The interviews were recorded directly in digital audio files, then transcribed using Verbal Ink®. Themes were derived after the data were organized using Dedoose® and then coded. RESULTS: Children and AYAs described the cancer experience as difficult due to activity challenges and disconnection from school. Patients noted that their physical inactivity led to deconditioning. Children and AYAs reported storytelling as a way to cope with newfound disabilities. Patients reported that their illness allowed them to build closer relationships to family. Feelings on other issues arose, such as communication challenges experienced with transition from adult to pediatric hospitals. The value of altruism emerged as a way to provide purpose in their journey. CONCLUSIONS: Children and AYAs have particular concerns that the healthcare community needs to address. These qualitative findings have specific recommendations for practice.

Development of Vignettes to Explore Workplace Bullying.

Incivility and bullying in healthcare can impact care delivery and quality. There are challenges in research to making a direct link between the behaviors and patient outcomes. One way to address the challenges is through the creation of bullying vignettes that induce mood changes that reflect a feeling of being bullied. The purpose of this study was to develop workplace bullying textual vignettes and to test content validity. Cognitive interviewing was used by engaging content experts to rate 21 author-created vignettes for relevance, realism, and severity. Eleven vignettes were identified and have potential use in research, education, and practice.

Trends in anecdotal fox sightings in Tasmania accounted for by psychological factors.

There has been little evaluation of anecdotal sightings as a means to confirm new incursions of invasive species. This paper explores the potential for equivocal information communicated by the media to account for patterns of anecdotal reports. In 2001, it was widely reported that red foxes (Vulpes vulpes) had been deliberately released in the island state of Tasmania (Australia), although this claim was later revealed to be baseless. Regardless, by 2013 a total of 3153 anecdotal fox sightings had been reported by members of the public, which implied their distribution was wide. For each month in 2001-2003, we defined a monthly media index (MMI) of fox-related media coverage, an index of their relative seasonal abundance (abundance), and a factor denoting claims of fox evidence (claimed evidence) regardless of its evidentiary quality. We fitted a generalized linear model with Poisson error for monthly totals of anecdotal sightings with factors of year and claimed evidence and covariates of MMI, abundance, and hours of darkness. The collective effect of psychological factors (MMI, claimed evidence, and year) relative to biophysical factors (photoperiod and abundance) was highly significant (χ2 = 122.1, df = 6, p < 0.0001), whereas anticipated changes in abundance had no significant influence on reported sightings (p = 0.15). An annual index of fox media from 2001 to 2010 was strongly associated with the yearly tally of anecdotal sightings (p = 0.018). The odds ratio of sightings ranked as reliable by the fox eradication program in any year decreased exponentially at a rate of 0.00643 as the total number of sightings increased (p < 0.0001) and was indicative of an observer-expectancy bias. Our results suggest anecdotal sightings are highly susceptible to cognitive biases and when used to qualify and quantify species presence can contribute to flawed risk assessments.

On Anecdote and Antidotes: Poison Trials in Sixteenth-Century Europe.

This article describes the use of poison trials, in which an animal or a condemned criminal was poisoned, to test antidotes in sixteenth-century Europe. In contrast to most drug testing in medieval and early modern Europe, which was gathered in the normal course of therapeutic experience, the poison trial was a contrived, deliberate event. I argue that poison trials had an important function in both medical testing and medical writing in the period between 1524-1580. While poison trials dated back to antiquity, they tended to be described in medieval texts as theoretical possibilities rather than empirical tests that had already occurred. In contrast, early modern physicians conducted poison trials and described them as anecdotes in medical texts. Although physicians did not explicitly separate poison trials from evidence gathered in the course of regular therapeutic experience, they did imbue the outcome of poison trials with considerable epistemological weight.

A Slice of Hospital Toast a Day Keeps the Doctors at Bay.

Anecdotal evidence over the years has suggested that toast made in hospital, so called 'hospital toast' tastes better than toast made at home, or anywhere else for that matter. We carried out a prospective, multi-professional study to determine the views and the toast eating habits of NHS staff. Fifty members of NHS staff were surveyed across two hospital trusts. This included nursing staff, doctors from various specialties and allied health professionals. Results were overwhelming, a staggering 96% admitted to enjoying a slice of hospital toast while at work. In keeping with anecdotal evidence, 92% were adamant that hospital toast tasted better with multiple ingenious theories suggested for the reason behind this. So the rumours seem to be true, well, according to the 'bread and butter' of the NHS anyway; hospital toast tastes better than toast anywhere else. It provides fuel to busy healthcare professionals and overall boosts staff morale during trying times in the NHS. The mystery behind this magical hospital toast remains unsolved.

Nursing Students' Perceptions of Anecdotal Notes as Formative Feedback.

Anecdotal notes are a method of providing formative feedback to nursing students following clinical experiences. The extant literature on anecdotal notes is written only from the educator perspective, focusing on rationale for and methods of production, rather than on evaluation of effectiveness. A retrospective descriptive study was carried out with a cohort of 283 third year baccalaureate nursing students to explore their perceptions of anecdotal notes as effective formative feedback. The majority of students valued verbal as well as anecdotal note feedback. They preferred to receive feedback before the next learning experience. Students found the quality of feedback varied by instructor. The anecdotal note process was found to meet identified formative feedback requirements as well as the nursing program's requirement for transparency of evaluation and due process. It is necessary to provide professional development to clinical nurse educators to assist them develop high quality formative feedback using anecdotal notes.

Adding Spice to the Slog: Humanities in Medical Training.

Writing from personal experience, physician and author Danielle Ofri asks what evidence is needed to justify trying to humanize medical training via the power of literature.

A patient's dilemma: mitral regurgitation--to operate--or medical management?

A personal view of a difficult decision by a retired professor of medicine in the Netherlands, Dr Shiva Shivananda.

Misunderstood as mothers: women's stories of being hospitalized for illness in the postpartum period.

AIM: This paper aims to explore women's experiences with healthcare providers to ascertain ways health care may be improved for women disrupted in their mothering. BACKGROUND: Women can find it difficult to relinquish care even when they are acutely unwell requiring hospitalization. Despite mothering being a priority for women, many healthcare professionals do not understand the importance of continuing to mother during maternal illness. DESIGN: This research used a qualitative methodology drawing on principles of feminism and storytelling. METHODS: Women's stories were collected through face-to-face interviews, email and via the telephone. The twenty-seven women who participated were from either Australia or the USA, had between one and six children and identified themselves as having been disrupted in their mothering by illness. Data were collected in 2011 and were analysed thematically. FINDINGS: The majority of participants had been hospitalized at some point in time for acute illness. A subset of participants reported feeling judged by nurses and that their efforts to continue to mother their newborn children despite their illness were misunderstood and not facilitated. CONCLUSION: Findings from this study suggest that women are more likely to remember times that health professionals failed to understand the primacy that mothering held for them or facilitate their efforts to continue to mother despite illness. Nurses and midwives should regularly reflect on their personal values in regard to mothering, validate women's attempts to mother to the best of their ability during illness and find ways to support and empower women in their mothering.

Meanings of knowledge and identity in public health nursing in a time of transition: interpretations of public health nurses' narratives.

BACKGROUND: A changing healthcare system affects the professional identity of nursing groups. Public health nursing has experienced challenges in balancing the paternalistic expert ideology and the empowerment participation ideology. A strong professional identity can legitimate nursing, and possibly influence the quality of nursing work. Narrations from practice can illuminate the nurses' theoretical and practical knowledge and help illustrate their collective professional identity. AIM: To illuminate the meaning of public health nursing knowledge and professional identity in a continuously changing public health nursing practice. METHOD: A qualitative interview study with a purposeful sample of 23 Norwegian public health nurses was carried out. Data were analysed using phenomenological hermeneutics, a descriptive method inspired by Ricoeur's philosophy of interpretation. FINDINGS: Three themes emerged (i) Being a generalist: emphasising the need for generalised knowledge and using clinical judgement, (ii) Being one who empowers: focusing on resources and coping strategies, (iii) Being occupied with individual problem solving: focusing on individuals with special needs, using standardised techniques and protocols, and lacking specialised knowledge. CONCLUSION: Interpretation of the nurses' stories illuminated their need for generalised evidence-based knowledge, but also the importance of using sound clinical judgement in a diverse complex practice, where service users need encouragement, support and expert advice. Time pressures can limit the nurses' involvement. Many had an individual problem-focus more than a primary prevention focus, in contrast to governmental regulations stating that Norwegian public health nurses should focus on health promotion and primary prevention. Public health nurses have a broad generalised knowledge of their special target group giving them a 'specialist generalist' role. Clarification of this role, in relation to jurisdictional borders, can create a strong identity at a time when healthcare policy promotes economic values, professional neutrality and increased collaboration.

End of life of patients treated with haemodialysis as narrated by their close relatives.

AIM: The study aimed to describe end of life for patients treated with maintenance haemodialysis as narrated by their close relatives. INTRODUCTION: Many patients undergoing haemodialysis are older, have several comorbidities and underestimated symptoms and are in their last year of life. To improve care, we need to know more about their end-of-life situation. DESIGN: Qualitative and descriptive. METHODS: Qualitative retrospective interviews were conducted with 14 close relatives of deceased haemodialysis patients (3-13 months after death). Data were analysed using qualitative content analysis. The study is ethically approved. FINDINGS: In the last months, a gradual deterioration in health with acute episodes necessitating hospital admissions was described. This involved diminishing living space and expressions of dejection, but also of joy. Three patterns emerged in the last weeks: uncertain anticipation of death as life fades away; awaiting death after haemodialysis withdrawal; and sudden but not unexpected death following intensive care. Findings show complexities of decisions on haemodialysis withdrawal. CONCLUSIONS: Different end-of-life patterns all involved increasingly complex care needs and existential issues. Findings show a need for earlier care planning. The identification of organisational factors to facilitate continuity and whole person care to meet these patients' specific care needs with their complex symptom burdens and comorbidities is needed. Findings indicate the need for integration of a palliative care approach in the treatment of patients in haemodialysis care.

Seymour Sarason Remembered: "Plus ça change ", "Psychology Misdirected", and "Community Psychology and the Anarchist Insight".

The intellectual legacy of Seymour Sarason continues to serve as a critical resource for the field of community psychology. The present paper draws on one of Sarason's favorite aphorisms and two of his seminal writings to suggest the relevance of ideas articulated 35-40 years ago for the current time. Each in their own way highlights the importance of unearthing and interrogating core assumptions underlying our research and our efforts to make a positive difference. The aphorism reminds us that the rhetoric of change is far easier to articulate than to enact and all too often ignores or disguises issues of power among actors. The "misdirection" of Psychology reflected his assertion that the asocial, acultural, and ahistorical nature of American Psychology reflected American culture more generally and ill prepared it to understand and engage in social change, particularly with respect to educational reform. The "anarchist insight" articulated his belief in interrogating the implications of the increasingly interdependent relationship of science and the state for the autonomy of scientists and scientific inquiry. The evidence-based practice movement is offered as an example of the current day relevance of the aphorism and core insights of these two papers. The paper concludes with a plea to rekindle the discussion and continued examination of Sarason's paradigmatic insights for the intellectual and social development of the field.

Child-to-Parent Violence: An Exploratory Study of the Roles of Family Violence and Parental Discipline Through the Stories Told by Spanish Children and Their Parents.

The aim of this study was to identify the role of exposure to family violence and parental discipline in the development of child-to-parent violence (CPV). A qualitative in-depth interview design was used. Fifteen adolescents (10 boys) who have perpetrated CPV (Mage=16 years; SDage=1.33 years) and their parents or foster parents took part in the study. Individually, they answered questions about exposure to violence and parenting practices. Results suggest that adolescents were frequently direct victims and also witnesses of violence. Furthermore, emotional neglect in the parent-child relationship was frequent and families were characterized by rules that are not consistently implemented. Different forms of violence seem to coexist in these families, and CPV should also be a target in the interventions.

An Integrative Professional Theory and Practice Paper: Personal Reflections from the Journey through Clinical Pastoral Education.

CPE is an experience-based approach to learning spiritual care which combines clinical care with qualified supervision, in-class education and group reflection (CASC--http://www.spiritualcare.ca/). Through didactic seminars, group presentations and personal reading there is opportunity for the student to acquire, apply and integrate relevant theoretical information into their practice. Written for my CPE Specialist application, this paper describes how, through the course of advanced CPE education, I learn to utilize and integrate theory into my clinical work. Beginning with three strands--authenticity, listening and storytelling--I then discuss how the behavioural sciences and theology inform my practice. Focusing on empathy, I speak of the application of disclosure, the use of counter-transference as a diagnostic tool, and the place of therapeutic termination. Group theory, family systems theory, theological reflection, liturgical ministry, and multi-faith practices are considered.

The Evolution of Research Paradigms in Pastoral/Spiritual Care, Counseling, and Education.

This partially autobiographical article is presented as a chapter in the narrative of the evolution of research methodology in the social sciences and the impact that evolution has had on pastoral/spiritual care research as the author has experienced and observed it during the latter part of the 20th century and the early years of the 21st century.