Ecopsychosocial accompaniment: Cocreating with humility.

When Seymour Sarason, the founder of American community psychology, looked back on his life and work, he singled out the importance of personal humility and of developing collaborative learning relationships. He worried that humility was too lacking in psychology. To cultivate humility, we need to engage in an ongoing practice of critical self- and group-examination that enables us to understand more fully the effects of our positionalities, historical, and cultural contexts. Alongside this we need to try to understand the ecopsychosocial and historical contexts of those we have been invited to accompany. For those who are European descended, this requires a deepening realization of how we, as W. E. B. Du Bois would say, have been and are a "problem." Unawares, we have saturated psychology with our own cultural perspectives and ways of being. "White" people require their own pedagogy to become more conscious of their standpoints and to redress the harms created by their group. Our task is not to evangelize psychological theories and practices born from within our own particular cultural perspective, but to learn from the cultural workers and community members in the group we are working with. We must ask of ourselves questions that enable us to understand the broader historical, social, and ecological context of the issues that are presenting. To indicate this, I preface the term "accompaniment" with the adjective "ecopsychosocial." Ecopsychosocial accompaniment requires humility. It is humility that opens the door to being able to imagine and desire together, to cocreate, and cosustain the kinds of decolonial spaces, places, and ways of working and living with one another that are so desperately needed.

Engaging the Struggle for Decolonial Approaches to Teaching Community Psychology.

Community psychology's history has traditionally been described within the context of U.S. history, silencing contributions from people of color from the Americas, Asia, the Pacific Islands, and Africa. In a MA/PhD specialization in Community Psychology, Liberation Psychology, Indigenous Psychologies, and Ecopsychology at Pacifica Graduate Institute, we are attempting to steer into critical dialogues about modernity, coloniality, and decoloniality, closely examining our curriculum and pedagogy, including our approaches to fieldwork and research. Turning to Indigenous psychologists, decolonial and critical race theorists, and cultural workers within the U.S. and from the Global South, we are attempting to challenge coloniality in the social sciences, community psychology, and in our own thinking and teaching to unmask hegemonic assumptions and open space for decolonial theory and practice. In this paper, we explore ways in which we are working with our graduate students and faculty to co-construct a decolonial curriculum that integrates decoloniality so that knowledges from historically silenced locations, as well as anti-racist and other decolonial praxes can co-exist and thrive.

Implementation and prospective clinical validation of AI-based planning and shimming techniques in cardiac MRI.

PURPOSE: Cardiovascular magnetic resonance (CMR) is a vital diagnostic tool in the management of cardiovascular diseases. The advent of advanced CMR technologies combined with artificial intelligence (AI) has the potential to simplify imaging, reduce image acquisition time without compromising image quality (IQ), and improve magnetic field uniformity. Here, we aim to implement two AI-based deep learning techniques for automatic slice alignment and cardiac shimming and evaluate their performance in clinical cardiac magnetic resonance imaging (MRI). METHODS: Two deep neural networks were developed, trained, and validated on pre-acquired cardiac MRI datasets (>500 subjects) to achieve automatic slice planning and shimming (implemented in the scanner) for CMR. To examine the performance of our automated cardiac planning (EasyScan) and AI-based shim (AI shim), two prospective studies were performed subsequently. For the EasyScan validation, 10 healthy subjects underwent two identical CMR protocols: with manual cardiac planning and with AI-based EasyScan to assess protocol scan time difference and accuracy of cardiac plane prescriptions on a 1.5 T clinical MRI scanner. For the AI shim validation, a total of 20 subjects were recruited: 10 healthy and 10 cardio-oncology patients with referrals for a CMR examination. Cine images were obtained with standard cardiac volume shim and with AI shim to assess signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), overall IQ (sharpness and MR image degradation), ejection fraction (EF), and absolute wall thickening. A hybrid statistical method using of nonparametric (Wilcoxon) and parametric (t-test) assessments was employed for statistical analyses. RESULTS: CMR protocol with AI-based plane prescriptions, EasyScan, minimized operator dependence and reduced overall scanning time by over 2 min (∼13 % faster, p < 0.001) compared to the protocol with manual cardiac planning. EasyScan plane prescriptions also demonstrated more accurate (less plane angulation errors from planes manually prescribed by a certified cardiac MRI technologist) cardiac planes than previously reported strategies. Additionally, AI shim resulted in improved B0 field homogeneity. Cine images obtained with AI shim revealed a significantly higher SNR (12.49%; p = 0.002) than those obtained with volume shim (volume shim: 32.90 ± 7.42 vs. AI shim: 37.01 ± 8.87) for the left ventricle (LV) myocardium. LV myocardium CNR was 12.48% higher for cine imaging with AI shim (149.02 ± 39.15) than volume shim (132.49 ± 33.94). Images obtained with AI shim resulted in sharper images than those obtained with volume shim (p = 0.012). The LVEF and absolute wall thickening also showed that differences exist between the two shimming methods. The LVEF by AI shim was shown to be slightly larger than LVEF by volume shim in two groups: 2.87% higher with AI shim for the healthy group and 1.70% higher with AI shim for the patient group. The LV absolute wall thickening (in mm) also showed that differences exist between shimming methods for each group with larger changes observed in the patient group (healthy: 3.31%, p = 0.234 and patient group: 7.29%, p = 0.059). CONCLUSIONS: CMR exams using EasyScan for cardiac planning demonstrated accelerated cardiac exam compared to the CMR protocol with manual cardiac planning. Improved and more uniform B0 magnetic field homogeneity also achieved using AI shim technique compared to volume shimming.

Lone voices have an emotional content: focussing on mental health service user and carer involvement.

PURPOSE: The purpose of this paper is to describe learning gained from involving service users and carers as researchers in an action research study. The researchers aimed to introduce self-directed support in mental health services--part of the government's personalisation agenda, which requires a move from current social care commissioning, where a person is matched to available services, to one where a person self-assesses, has an agreed support plan and then with appropriate help, purchases his or her own services to lead as independent a life as possible. This development is allied closely with the mental health service recovery approach. DESIGN/METHODOLOGY/APPROACH: Three service users and two carers were recruited to work alongside the lead researcher. Service users were fully involved in the steering group - part of participatory action research project. Data were collected from: debriefing meetings with co-researchers between April and December 2007; a group interview held by the lead researcher; and participants' journal comments and self-reflections. FINDINGS: The main areas in which service users and carers found involvement difficult were: overcoming professional language barriers; emotional impact; and power imbalances between themselves and professionals. Findings suggest that considerable improvement is required by mental health professionals and managers if service users and carers are successfully involved in projects. RESEARCH LIMITATIONS/IMPLICATIONS: This is a small study within a larger action research project. Findings are not generalisable owing to the small sample; however, findings are supported by the service-user involvement literature. ORIGINALITY/VALUE: Few studies explore participation effects on service users and carers from their perspective. This research provides insights into what needs to be addressed to improve service user and carer involvement to improve mental health services.

Assessing the impact of nurse and allied health professional consultants: developing an activity diary.

AIMS: To construct and test an activity diary designed to measure the impact and explore the activities of nurse and allied health professional consultants in relation to each speciality and function of the role. BACKGROUND: This was part of a funded feasibility study to assess the contribution of nurse and allied health professional consultants. DESIGN: This was an exploratory study. METHOD: Thematic analysis of guided discussions with five nurse consultants and one physiotherapy consultant identified activities which were used to construct an activity diary. The activities were grouped under the four pillars or functions of the consultant role; expert practice, leadership, research and education. Participants recorded their activities in a diary over a one-week period. CONCLUSION: Results suggest that with some modification, this activity diary could be used to capture the impact, complexity and diversity of activities of the consultant role. RELEVANCE TO PRACTICE: Advanced practice roles are essential to the healthcare workforce of the future. This tool provides a method for measuring the contribution and complexity of the consultant role.

A survey of a HBCU's senior year nursing students' perception of the HIV/AIDS phenomenon: a follow-up study.

This study was a follow-up to a previous study that was done among first semester nursing college students at a historically Black college and university in northeastern United States. The original intent was to ascertain their perceptions and knowledge of various aspects of the Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) phenomenon. It involved an anonymous survey questionnaire featuring yes and no answers, a Likert scale, and qualitative response questions concerning prevention behavior. Respondents were asked whether HIV/AIDS could make an individual "sick enough to die", whether they thought that wearing a condom would diminish their feeling during the sexual experience, and whether they would insist their partners use a condom. The original study consisted of 68 students. The follow-up study,four years later, consisted of the 20 remaining nursing students from the original cohort and was undertaken with the intent to appraise their knowledge level and to ascertain whether their attitudes towards the use of condoms as a way to prevent HIV/AIDS and STDs had changed. Findings from this follow-up study indicated that educational attainment of the respondents did not translate into a change in attitudes about responsible sexual behavior. Further findings may suggest that intensive HIV/AIDS education begin at an earlier phase in a students'education. Along with the basics of HIV/AIDS education, students need to learn to be respectful of each others' health and wellbeing. It is essential that a nurturing and protective environment exist so that young women are not afraid of the consequences related to asking partners to wear condoms during sexual encounters.

The clinical content of NHS trust board meetings: an initial exploration.

OBJECTIVES: To differentiate between English NHS trust board meetings according to the percentage of clinical content and to explore which characteristics of board meetings might explain this. METHODS: Definition of scoring system for clinical content. Scoring of minutes for a random sample of 60 trusts. Qualitative analysis of a sub-sample, generated hypotheses about factors leading to higher percentage of clinical items was undertaken; testing of hypotheses in a longitudinal sample of minutes from 24 trusts over 1 year. RESULTS: Clinical content varied from 2% to 30%. Boards with a more clinical focus tended to link other issues including finance to clinical issues; have non-executive directors able to question board executives openly; make less use of acronyms in minutes; had more liaison with social services; and accepted questions from the public. CONCLUSIONS: Counting items in board minutes has prima facie validity as a means of defining how clinically focussed board meetings are, although more research is required to refine the method. The present method of analysing board minutes may provide one way of assessing board culture. IMPLICATIONS FOR NURSING MANAGEMENT: Directors of nursing can help focus trust board meetings on clinical matters. Further research is required to determine whether greater clinical content in trust board meetings has impacts on clinical practice or organizational performance.

What is the impact of professional nursing on patients' outcomes globally? An overview of research evidence.

BACKGROUND: Nursing is an integral part of all healthcare services, and has the potential of having a wide and enduring impact on health outcomes for a global ageing population. Over time nurses have developed new roles and assumed greater responsibilities. It is increasingly important to demonstrate the safety and overall impact of nurses' practice through research, to support the case for greater investment and development of nursing services around the world. OBJECTIVE: To provide an overview of existing research evidence on the impact of nursing on patient outcomes, identify gaps in evidence, and point to future priorities for global research. Specifically to address two questions: what is the evidence that nursing contributes to improving the health and well-being of populations?; and where should research activity be focused to strengthen the evidence base for the impact of nursing? METHODS: A search of the literature from 1996 using CINAHL, MEDLINE, the Cochrane Library, Google Scholar and the NICE evidence databases using the key words: nursing, nurse led, nursing interventions and patient outcomes. Initial analysis of the retrieved citations to reveal clusters of evidence of nursing impact in clinical areas which had been subject to systematic/integrative reviews or meta-analyses. Further analysis of these reviews to provide an overview of the research evidence for nurses' contributions to healthcare to inform discussion on future research agendas. We use the terms low, moderate and high quality evidence to reflect the assessments made by the review authors whose work is presented throughout. RESULTS: Analysis of 61 reviews, including ten Cochrane reviews and two scoping/selective reviews to provide a summary of the research evidence for nurses' contributions to healthcare in the following areas of practice: nursing in acute care settings; nurses' involvement in public health; the contribution of specialist nurse and nurse-led services to the management of chronic disease; comparison of care provided by nurses and doctors; and task shifting to invasive procedures. CONCLUSIONS: There is evidence that adequate numbers of well-educated nurses working in acute care areas can reduce the risk of patient mortality, although the evidence for this is confined to studies in high income countries and the evidence is not sufficiently robust to draw up definitive nurse: patient ratios. There is also moderate evidence that well trained nurses can produce health outcomes that are equivalent to those of doctors for patients with a range of chronic health problems, particularly for those patients managed in primary care, and that nurse-led care may be more effective than medical care in promoting patient adherence to treatment and patient satisfaction. There is low to moderate evidence for the benefits of parenting support programmes delivered by nurses on a range of health outcomes; and for the impact of home visiting on improving function and other health service outcomes for older people. The wider societal benefits of home visiting by nurses and the impact of this on long term outcomes and related cost-effectiveness of home visiting has not been established. There is limited available information regarding the wider global impact of increasing the numbers of nurses and their contribution to healthcare through improved education. Moreover there is very little evidence for the cost-effectiveness of changing care providers from doctors to nurses and as the majority of cost data available has tended to come from studies based in higher income countries, their external validity in terms of applicability to settings in low and middle income countries is questionable. In addition to effectiveness, cost and safety, future research needs to address how implementing expanded nursing roles and task shifting impacts on the morale, retention, and professional development of nurses and the other workforces, and the longer term implications of these developments both locally and internationally.

A quick survey of an HBCU's first year nursing students' perception of the HIV/AIDS phenomenon.

There are always some assumptions that are made about the knowledge of the Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) phenomenon among graduating high school seniors. To ascertain their knowledge, a categorical survey questionnaire was designed featuring yes and no answers, a Likert scale, and qualitative response questions to the problem of HIV/AIDS prevention behavior. It was administered to first semester nursing college students at an historically black college and university (HBCU) in northeastern United States. These freshman students were enrolled in the course University Seminar. The class consisted of 68 students (64 females and 4 males). The students in this class anonymously completed the questionnaire about their perceptions and knowledge of the HIV/AIDS phenomenon. Findings from the study indicated that the majority of the students knew that HIV/AIDS could make an individual sick enough to die. The students stated, however, that they were willing to submit to the sexual demands of their partners, even when they refused to wear condoms. Of the 64 female students who responded to the questionnaire, 38 stated that using a condom might diminish their feeling during the sexual experience and they thought that it was very important that that did not happen. Therefore, this situation might affect a student's decision as to whether or not to insist on using a condom. In conclusion, it is recommended that intensive HIV/AIDS education be incorporated into the curriculum and the questionnaire be repeated in these students' junior and senior years to ascertain whether or not there was a change in their attitudes.

New hybrid online graduate program in medical imaging graduates its first class of students.

According to the American Registry of Radiologic Technologists (ARRT), the current shortage of radiologic technologists (RTs) will continue to grow and by 2010, when many RTs are expected to retire from the profession, there will be an estimated 24,000 vacancies. In response to the shortage of RTs, The MGH Institute of Health Professions has developed a fast-track hybrid online graduate program in medical imaging (MI) which is geared toward bachelor degree prepared students who are seeking to make a career change. By targeting bachelor prepared students, the Institute seeks to attract academically mature students who will make a sustaining contribution to the field of radiologic science. The first class of students in this new online program just graduated. Measured results of this first group are very encouraging with all results exceeding the goals initially set for the program. Except for one student who has visa issues precluding employment, all of the students from the class have passed their registry exam and are employed in the field. The format of this new online MI program eases constraints on growth and viability and it bridges the gap between entry-level and advanced practice. This hybrid online program is a model that could be implemented with healthcare systems nationwide.

Practical value of cardiac magnetic resonance imaging for clinical quantification of aortic valve stenosis: comparison with echocardiography.

BACKGROUND: Valvular pathology can be analyzed quickly and accurately through the use of Doppler ultrasound. For aortic stenosis, the continuity equation approach with Doppler velocity-time integral (VTI) data is by far the most commonly used clinical method of quantification. In view of the emerging popularity of cardiac magnetic resonance (CMR) as a routine clinical imaging tool, the purposes of this study were to define the reliability of velocity-encoded CMR as a routine method for quantifying stenotic aortic valve area, to compare this method with the accepted standard, and to evaluate its reproducibility. METHODS AND RESULTS: Patients (n=24) with aortic stenosis (ranging from 0.5 to 1.8 cm2) were imaged with CMR and echocardiography. Velocity-encoded CMR was used to obtain velocity information in the aorta and left ventricular outflow tract. From this flow data, pressure gradients were estimated by means of the modified Bernoulli equation, and VTIs were calculated to estimate aortic valve orifice dimensions by means of the continuity equation. The correlation coefficients between modalities for pressure gradients were r=0.83 for peak and r=0.87 for mean. The measurements of VTI correlated well, leading to an overall strong correlation between modalities for the estimation of valve dimension (r=0.83, by means of the identified best approach). For 5 patients, the CMR examination was repeated using the best approach. The repeat calculations of valve size correlated well (r=0.94). CONCLUSIONS: Velocity-encoded CMR can be used as a reliable, user-friendly tool to evaluate stenotic aortic valves. The measurements of pressure gradients, VTIs, and the valve dimension correlate well with the accepted standard of Doppler ultrasound.

Quantification of stenotic mitral valve area with magnetic resonance imaging and comparison with Doppler ultrasound.

OBJECTIVES: The purpose of this study was to evaluate the reliability of the pressure half-time (PHT) method for estimating mitral valve areas (MVAs) by velocity-encoded cardiovascular magnetic resonance (VE-CMR) and to compare the method with paired Doppler ultrasound. BACKGROUND: The pressure half-time Doppler echocardiography method is a practical technique for clinical evaluation of mitral stenosis. As CMR continues evolving as a routine clinical tool, its use for estimating MVA requires thorough evaluation. METHODS: Seventeen patients with mitral stenosis underwent echocardiography and CMR. Using VE-CMR, MVA was estimated by PHT method. Additionally, peak E and peak A velocities were defined. Interobserver repeatability of VE-CMR was evaluated. RESULTS: By Doppler, MVAs ranged from 0.87 to 4.49 cm2; by CMR, 0.91 to 2.70 cm2, correlating well between modalities (r = 0.86). The correlation coefficient for peak E and peak A between modalities was 0.81 and 0.89, respectively. Velocity-encoded CMR data analysis provided robust, repeatable estimates of peak E, peak A, and MVA (r = 0.99, 0.99, and 0.96, respectively). CONCLUSIONS: Velocity-encoded cardiovascular magnetic resonance can be used routinely as a robust tool to quantify MVA via mitral flow velocity analysis with PHT method.

Establishing minimal clinically important differences for scores on the pediatric evaluation of disability inventory for inpatient rehabilitation.

BACKGROUND AND PURPOSE: Standardized pediatric assessment tools such as the Pediatric Evaluation of Disability Inventory (PEDI) numerically quantify changes during rehabilitation through test scores, but they are unable to provide client-specific information regarding important changes in function. The purpose of this study was to identify the smallest change in PEDI scores during inpatient rehabilitation that was considered to be a minimal clinically important difference (MCID) by physical therapists and other clinicians. SUBJECTS AND METHODS: A retrospective review was done of the medical charts of 53 children and youth (1-19 years of age) discharged from an inpatient rehabilitation hospital. Fifteen clinicians (5 physical therapists, 6 occupational therapists, and 4 speech and language pathologists) who were masked to the PEDI scores provided ratings of the magnitude of functional changes during inpatient rehabilitation using a Likert scale and a visual analog scale (VAS). Ratings by clinicians were reduced to 4 categories, including the MCID, and compared with PEDI change scores. RESULTS: The MCIDs ranged from 6 to 15 points (X=11.5, 95% confidence interval= +/- 2.8) for all PEDI scales. Likert scale and VAS ratings were correlated (tau =.73-.80). DISCUSSION AND CONCLUSION: Across all scales, PEDI change scores on the order of about 11% (0-100 scale) appear to be meaningful to clinicians during a child's or adolescent's inpatient rehabilitation. These data can serve as a starting point for interpreting group and individual changes on the PEDI during physical therapy intervention in inpatient rehabilitation.

Treadmill ambulation with partial body weight support for the treatment of low back and leg pain.

STUDY DESIGN: A single-subject experimental design using an A-B-A treatment protocol. OBJECTIVE: To determine whether walking on a treadmill with partial body weight support (PBWS) would be an effective adjunct treatment method to standard care for decreasing pain and increasing function in patients suffering from low back and leg pain. BACKGROUND: Mechanical low back pain (LBP) is commonly aggravated by activities that increase axial loading in the spine, such as sitting, standing, and walking. Patients with mechanical LBP usually describe relief with positions that unload the spine. One traction technique now being used in clinics to unload the spine is the PBWS system. The use of endurance exercise has also been found to be a consistent predictor of better outcomes in patients with LBP. Thus treatment that combines spinal unloading using PBWS and endurance exercise may be an effective intervention for patients with low back and leg pain. METHODS AND MEASURES: Eleven subjects participated in this study using an A-B-A design. Phase A was defined as the baseline condition and phase B was intervention with PBWS provided by a mechanical unloading system. The Roland-Morris Questionnaire (RMQ) and Visual Analog Scale (VAS) were utilized to collect data on functional status and perceived pain, respectively. Visual Analysis and 2 standard deviation band method (2SDBM) were used to analyze the data. RESULTS: Pain scores between baseline and PBWS treatment phases were significantly improved for 3 out of the 6 subjects who completed the study. RMQ baseline and treatment scores revealed that 5 out of 6 subjects had significant functional improvements in the PBWS treatment phase. CONCLUSION: The results suggest that ambulation with PBWS combined with the standard level of care for this population holds sufficient promise for pain relief and functional improvement to justify testing its efficacy in larger groups of subjects with these complaints.

Bicuspid Pulmonic Valve and Pulmonary Artery Aneurysm.

Bicuspid pulmonary valves and pulmonary artery aneurysms are two rare entities, reported in association, and usually attributed to hemodynamic alterations caused by the bicuspid pulmonary valve. We present magnetic resonance images of a patient with a bicuspid pulmonary valve and pulmonary artery aneurysm, and propose an alternative mechanism for this association, based on recent embryologic studies that link anomalies of the semilunar valves and great vessels with derangement of the cardiac neural crest cell development.

Measuring the contribution and complexity of nurse and physiotherapy consultants: a feasibility study.

Advanced practice roles in nursing and other health professions have become integral to a range of healthcare services world-wide providing experienced practitioners with the opportunity to extend their roles and influence decision making whilst maintaining patient contact. However, there has been limited research to evaluate the impact on health services of these advanced practice roles.The aim of this feasibility study was to analyse Nurse and Allied Health Professionals (AHP) Consultant activity in the four functions of the role (education, expert practice, leadership, research). A structured diary assessed the activity of five Consultant Nurses and one Consultant Physiotherapist over a one week period. Detailed analysis of a clinic carried out by one of the Consultants was undertaken using a mapping procedure.Results suggest that the activity diary, combined with mapping of activities, illustrate the complexity and variety of the role and facilitate meaningful reflection on what advanced practitioners do.

A systematic review and meta-synthesis: evaluating the effectiveness of nurse, midwife/allied health professional consultants.

AIM: This paper presents the findings of a systematic review and meta-synthesis, which was undertaken to identify and assess studies that evaluated the nurse/midwife/allied health professional consultant role. BACKGROUND: As part of the modernization agenda in the National Health Service the United Kingdom government proposed 'Consultant' posts for nurses/midwives and allied health professionals as an opportunity for experienced practitioners to extend their roles. Four key functions were identified as being significant to this role development: expert practice, leadership, education and research. Explicit within the proposal was a requirement of these new roles to be evaluated. METHOD: Inclusion criteria focussed on studies where an aspect of the role had been evaluated or where the consultant carried out the research. A total of 1931 citations was filtered to reveal 107 studies that possibly met the inclusion criteria. Of these 107, 14 studies were critically appraised and subjected to thematic analysis. Study methodology varied but of the 14 studies, 10 involved some form of measurement. The others adopted a literature review or descriptive approach. CONCLUSIONS: The extent to which consultants were involved in all aspects of the 'four pillars' was assessed in only a small number of studies. However, a number of studies implicitly implied active engagement in expert practice and leadership by focussing on specific service developments. RELEVANCE TO CLINICAL PRACTICE: To date, a number of studies evaluating service developments, education, expert practice and leadership have been carried out. However although a number of studies have assessed perceived impact of the consultant role, no measure of actual benefit has been published to date. Studies that evaluate the cost benefit/outcomes of these roles in relation to both activity and quality of service are required.