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1.
BMC Med Educ ; 24(1): 291, 2024 Mar 15.
Artículo en Inglés | MEDLINE | ID: mdl-38491476

RESUMEN

BACKGROUND: Compassionate care lies at the foundation of good patient care and is a quality that patients and providers continue to value in the fast-paced setting of contemporary medicine. Compassion is often discussed superficially in medical school curricula, but the practical aspect of learning this skill is often not taught using a formal framework. In the present work, the authors present an 8-session curriculum with a mindfulness-based approach to compassion that addresses this need. It is hypothesized that students in this curriculum will improve in their levels of compassion based on validated scales. METHODS: The curriculum was delivered to fourth-year medical students at Renaissance School of Medicine at Stony Brook University who had just completed their clerkship year. It was developed as a customizable set of modules that could be delivered in various ways. The students were taught with evidence-based cognitive exercises followed by group discussions and written reflections based on compassion-focused thematic questions. All students completed a pre- and post-Self-Compassion Scale, Compassion Scale, and Toronto Mindfulness Scale. Students in this course were compared with students in different courses about non-clinical topics delivered at the same time. Wilcoxon Signed Rank tests and Mann Whitney U tests were used to assess potential associations between pre- and post-survey responses for the validated scales and subscales. RESULTS: 17 fourth-year medical students completed pre- and post-course tests, 11 participated in the compassion curriculum while 6 participated from the other courses. Before any of the courses began, all students performed similarly on the pre-test across all scales. The students in the compassion curriculum demonstrated a significant increase in their total Self-Compassion score by 8.7 [95% CI 4.3 to 13.2] points (p = 0.008), total Compassion score by 6.0 [95% CI 1.4 to 10.6] points (p = 0.012), and the curiosity component of the Toronto Mindfulness Scale by 4.4 [95% CI 1.0 to 7.7] points (p = 0.012). There was no statistically significant difference between pre- and post-tests among the non-compassion curriculum students in the aforementioned scales (p = 0.461, p = 0.144, p = 0.785, respectively). CONCLUSIONS: Our results indicate that the students in our course developed an enhanced ability to engage in self-compassion, to understand the shared human experience, and to be motivated to act to alleviate suffering. Regardless of a program's existing compassion education, this customizable model allows for easy integration into a medical student's crowded curriculum. Furthermore, although teaching compassion early and often in a clinician's training is desirable, our study that targeted fourth-year medical students suggests an additional benefit of rekindling the loss of compassion well described in a medical student's clinical years.


Asunto(s)
Educación de Pregrado en Medicina , Medicina , Estudiantes de Medicina , Humanos , Estudiantes de Medicina/psicología , Empatía , Curriculum , Educación de Pregrado en Medicina/métodos
2.
JAMA ; 331(9): 729-730, 2024 03 05.
Artículo en Inglés | MEDLINE | ID: mdl-38334986

RESUMEN

This Viewpoint discusses the role of touch in medical tradition and its importance in medicine today.

3.
J Alzheimers Dis ; 98(1): 3-11, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38339937

RESUMEN

Background: Even in severe states of Alzheimer's disease and related dementias (ADRD), accounts of an unexpected or paradoxical return of awareness and lucidity have been reported in some patients, documented formally, and studied. Objective: A scoping review was undertaken to survey the literature on the topic. Methods: Five databases were searched using pertinent search terms. Results were deduplicated and subsequently screened by title and abstract for relevance. Remaining reports were read and included or excluded using specific inclusion criteria. 30 results consisted of a mix of perspective papers, case reports, qualitative surveys of caregivers, law journal comments, and mechanistic speculation. Results: An equal mix of primary and secondary research was identified. Conclusions: The papers collected in this review provide a valuable methodological outline for researching the topic of lucid episodes in ADRD. The verified legitimacy and simultaneous inexplicability of these events promote philosophical discussion, mechanistic investigations, and sorely needed research in the field of ADRD.


Asunto(s)
Enfermedad de Alzheimer , Humanos , Cuidadores , Cognición
4.
PLoS One ; 18(7): e0288766, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-37467230

RESUMEN

BACKGROUND: Empathy and compassion currently receive the most attention in healthcare with respect to the medical humanities and while these skills are important for any clinician to learn, they are complex and can be daunting to healthcare trainees when first encountered. Kindness is a simple, time-sensitive behavior not yet well characterized in the healthcare setting. With this study, we aim to clearly define it as well as investigate a few common examples of kindness that might be used to create a scale for use in the healthcare setting. METHODS: A literature search was performed to rigorously define kindness. A kindness scale based on this definition was then compiled and administered to 45 patients across three outpatient clinical settings to evaluate the association between several actions and the patient's perception of kindness. RESULTS: Kind actions are small, take little effort, and are short in duration to their intended effect. We define kindness as an action that benefits another, as perceived by the recipient of the kind action. The results from our clinical study indicate several actions such as greeting the patient with a smile, asking questions about the patient's daily life, listening carefully, and appearing interested in the patient have a moderate strength correlation to a perception of kindness. The physician being perceived as kind also had a weak-moderate strength correlation to the patient subjectively reporting improvement after their visit. CONCLUSIONS: Definitions in the medical humanities are important as they guide the scales used to measure them. This article defines kindness and describes some examples of its manifestation in the healthcare setting. Our study indicates that performing kind actions may improve a patient's subjective perception of their care, however, future studies are needed to evaluate whether this benefit extends to health outcomes as has been demonstrated for skills such as empathy and good communication. "Constant kindness can accomplish much. As the sun makes ice melt, kindness causes misunderstanding, mistrust, and hostility to evaporate." ~Albert Schweitzer.


Asunto(s)
Atención a la Salud , Empatía , Humanos , Proyectos Piloto , Instituciones de Salud , Comunicación
5.
Hosp Pediatr ; 12(11): e400-e415, 2022 11 01.
Artículo en Inglés | MEDLINE | ID: mdl-36239095

RESUMEN

CONTEXT: The utilization of Child Life Services is influenced by interprofessional collaboration and perceptions of other members of the medical team. OBJECTIVES: To summarize studies which address pediatric health care team perspectives on Child Life Services and their utilization in the hospital setting. DATA SOURCES: A comprehensive literature search was conducted with controlled vocabularies and key terms in MEDLINE, Embase, CINAHL, PsycInfo, and Web of Science. STUDY SELECTION: Primary studies published before November 2021 were screened using a predetermined set of inclusion and exclusion criteria. DATA CHARTING: Data charting was performed by 2 independent reviewers. Data extracted include baseline study characteristics, common themes, main outcomes, strengths, and limitations. Because this is not a systematic review, data from included studies was not quantitatively analyzed, but carefully summarized in the manner of a standard scoping review. RESULTS: Nine studies met criteria for inclusion. Common qualitative themes on certified child life specialists include: (1) their broad responsibilities, (2) their positive impact on patients and families, (3) challenges with interprofessional collaboration and integration, and (4) the value of educating others on their roles and responsibilities. CONCLUSIONS: Medical subject headings, controlled vocabulary, or other standardized subject headings that index literature on Child Life Services is limited. However, the existing body of literature supports the positive impact certified child life specialists have on patients and families, despite challenges with complete integration into the interdisciplinary care team. Additional research is required to fully understand and overcome these challenges in continued efforts to further drive patient and family-centered care.


Asunto(s)
Pacientes Internos , Grupo de Atención al Paciente , Humanos , Niño , Atención a la Salud , Hospitales , Familia
6.
Perspect Biol Med ; 65(3): 458-468, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-36093777

RESUMEN

Educating medical students to be physicians involves many dimensions. But in an educational culture where science and technology dominate the curriculum, these subjects also too often dominate the academic value system as well. While a firm grasp of scientific knowledge and technical skill is essential, cultivating humanistic virtues is at the core of all good medical care and the full well-being of those within it. This article describes a formative educational process that points towards compassionate flourishing and unfolds through dialogue and reflection on the human aspects of patient care and the student experience, a process coequal in value to scientific development. This educational process has been successfully implemented at the Center for Medical Humanities, Compassionate Care, and Bioethics at Stony Brook. When supported by a broader institutional culture through an ongoing reflective group process in residencies and other clinical settings, this process fosters professional flourishing, which leads to deeper meaning and compassionate care of patients.


Asunto(s)
Bioética , Educación Médica , Estudiantes de Medicina , Bioética/educación , Curriculum , Humanidades/educación , Humanos
7.
Med Sci Educ ; 32(5): 1149-1157, 2022 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-36160291

RESUMEN

Objective: Volunteerism represents an important mechanism to promote resilience, empathy, and general well-being in medical students, a group that stands to benefit. Medical students report feelings of fatigue, burnout, exhaustion, and stress that correlates with poor academic performance, and significant decline in empathy over the 3rd year of both MD and DO programs. Volunteer motivations have been shown to mediate participant well-being. The relationship between medical student volunteer motivations and specific outcomes during the COVID-19 pandemic has not been addressed. Methods: We characterized features of medical student volunteers during the COVID-19 pandemic in 2020, including volunteering motivation using the Volunteer Functions Inventory, the types of activities in which they participated, and the physical, psychosocial, and emotional outcomes they experienced following volunteering. Results: Altruistic and humanitarian values-centric motivation predicts positive volunteering outcomes including increased resilience, ability to deal with disappointment and loss, and ability to cope with the COVID-19 pandemic. Values-centric motivation also increases volunteer empathy independent of educational stage. Values-centric participants were more likely to select volunteering activities with patient contact, which promotes student empathy and resilience. Conversely, career-centric motivation does not predict positive outcomes. These students are more likely to engage in research-oriented activities. Conclusions: The efficacy of integrating volunteerism into medical school curricula may be limited by professional pressure that manifests as career-oriented motivation. We propose that practical integration should promote altruistic and humanitarian values-centric participant orientation to the volunteering process, which is associated with enhanced recruitment, preservation of empathy, and additional positive volunteering outcomes of interest.

8.
Hosp Pediatr ; 12(8): 703-710, 2022 08 01.
Artículo en Inglés | MEDLINE | ID: mdl-35791770

RESUMEN

BACKGROUND AND OBJECTIVES: Schwartz Rounds (SR) is an interdisciplinary program that focuses on compassionate care by allowing the formation of an interprofessional community around the human and emotional testimonies of caregivers. The purpose of this study was to examine the impact of implementing departmental SR on pediatric care providers at a tertiary care children's hospital in New York. METHODS: We applied the logic outcomes model for program evaluation to examine the impact of SR on pediatric providers. The standard evaluation form provided by the Schwartz Center was used to collect data after every SR. Descriptive statistics and qualitative data content analysis methods were used to analyze the evaluation data from the SR. RESULTS: A total of 820 standard evaluation forms were collected from 17 of the 23 SR sessions offered (response rate: 74.8%). Most participants felt that, during the SR sessions, challenging social and emotional aspects of patient care were discussed and that they gained better perspectives of their coworkers and their patients/families. They reported less isolation and more openness to express their feelings about patient care to their coworkers. The analysis of 299 written comments identified 5 themes: understanding other people's perspectives, the importance of communication, empathy and compassion, awareness of personal biases, and maintaining boundaries. CONCLUSIONS: Schwartz Rounds can provide an effective venue for pediatric care providers to gain insights into coworker and patient/family perspectives and process emotional experiences while providing patient care in a variety of circumstances.


Asunto(s)
Rondas de Enseñanza , Niño , Comunicación , Emociones , Empatía , Humanos , Atención al Paciente , Rondas de Enseñanza/métodos
9.
Am J Med ; 135(7): e224, 2022 07.
Artículo en Inglés | MEDLINE | ID: mdl-35504736
10.
Ann N Y Acad Sci ; 1511(1): 5-21, 2022 05.
Artículo en Inglés | MEDLINE | ID: mdl-35181885

RESUMEN

An inadvertent consequence of advances in stem cell research, neuroscience, and resuscitation science has been to enable scientific insights regarding what happens to the human brain in relation to death. The scientific exploration of death is in large part possible due to the recognition that brain cells are more resilient to the effects of anoxia than assumed. Hence, brain cells become irreversibly damaged and "die" over hours to days postmortem. Resuscitation science has enabled life to be restored to millions of people after their hearts had stopped. These survivors have described a unique set of recollections in relation to death that appear universal. We review the literature, with a focus on death, the recalled experiences in relation to cardiac arrest, post-intensive care syndrome, and related phenomena that provide insights into potential mechanisms, ethical implications, and methodologic considerations for systematic investigation. We also identify issues and controversies related to the study of consciousness and the recalled experience of cardiac arrest and death in subjects who have been in a coma, with a view to standardize and facilitate future research.


Asunto(s)
Reanimación Cardiopulmonar , Paro Cardíaco , Encéfalo , Estado de Conciencia , Paro Cardíaco/terapia , Humanos , Recuerdo Mental
11.
Med Sci Educ ; 32(1): 111-120, 2022 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-35043080

RESUMEN

Objective: Effectively training medical students in compassion, communication, and empathy is essential in fostering a holistic approach to patient care. We sought to address this by implementing an early clinical experience service learning program for medical students in the initial years of their medical education. Methods: Medical students at Stony Brook University initiated, designed, and facilitated the volunteer program, which provides students a framework to learn magic therapy and engage with pediatric patients. The program includes an introductory presentation, training course, and organized bedside sessions with patients. To evaluate the program, a sample of participants partook in a focus group, written questionnaire, and/or online survey. Results: From 2015 to 2020, 130 students participated in magic therapy rounds, engaging 1391 patients. Nine themes of student benefit emerged from qualitative analysis, including acquisition of familiarity with the hospital and healthcare team, cultivation of communication skills, contribution to improvement of patient affect, development of empathic qualities and techniques, and improvement in psychological health. Students were very satisfied with their experiences and viewed the activity as helpful for patients, parents, staff, and themselves. Conclusions: The program engaged students in compassionate patient care within a holistic approach to patient care early in training. Supplementary Information: The online version contains supplementary material available at 10.1007/s40670-021-01456-y.

13.
Am J Med Sci ; 361(2): 146-150, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33349440

RESUMEN

The Covid-19 pandemic struck physicians at a time of unprecedented dissatisfaction and burnout, providing a stress test whose lessons might guide structural changes in healthcare. While selflessly rescuing patients from death, many doctors were exposed to unacceptable risk, with little protection for themselves, and, by extension, for their families and patients. This essay examines the basis and limits of duty to treat in a time of crisis and explores how these experiences could leave doctors morally stressed and even compromised. We question whether a physician-patient relationship that treats patients' safety and well-being as separate from their doctors' personal and professional values, needs, and dignity is the best way to deliver care. Such questions predated coronavirus but were brought to the forefront because of the epidemic. As physicians process their experiences, we hope to begin a deeper moral and social conversation that might help us be better prepared for future crises.


Asunto(s)
COVID-19/psicología , Principios Morales , Relaciones Médico-Paciente , Médicos/psicología , COVID-19/terapia , Humanos , Factores de Riesgo
14.
J Paediatr Child Health ; 56(10): 1496-1499, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-33015919

RESUMEN

Moving, or residential relocation, occurs frequently in childhood and adolescence as well as in adulthood, yet little scientific consensus exists on its impact upon health outcomes. This paper summarises the available literature on this broad topic and explores the currently known factors of importance surrounding residential relocation. There is already evidence to support an increased risk of suicidal ideation, psychiatric disorders including substance use disorders, functional impairments and future general medical health impairments in children, adolescents and adults with histories of residential relocation. Intrapersonal factors, such as personality type and the availability of coping skills, as well as interpersonal factors, such as family composition and system strengths, attenuate risk and are integral to additionally assess. While there is support for the contribution of residential relocation in the onset of youth psychopathology that warrant consideration of residential relocation in the standard assessment of a patient, further studies are needed to better explore this factor in select populations.


Asunto(s)
Adaptación Psicológica , Trastornos Relacionados con Sustancias , Adolescente , Adulto , Niño , Humanos , Atención al Paciente
20.
Psychosom Med ; 81(3): 256-264, 2019 04.
Artículo en Inglés | MEDLINE | ID: mdl-30688770

RESUMEN

OBJECTIVE: Psychological traits such as optimism and hostility affect coronary heart disease (CHD) risk, but mechanisms for this association are unclear. We hypothesized that optimism and hostility may affect CHD risk via changes in heart rate variability (HRV). METHODS: We conducted a longitudinal analysis using data from the Women's Health Initiative Myocardial Ischemia and Migraine Study. Participants underwent 24-hour ambulatory electrocardiogram monitoring 3 years after enrollment. Optimism (Life Orientation Test-Revised), cynical hostility (Cook-Medley), demographics, and coronary risk factors were assessed at baseline. HRV measures included standard deviation of average N-N intervals (SDNN); standard deviation of average N-N intervals for 5 minutes (SDANN); and average heart rate (HR). CHD was defined as the first occurrence of myocardial infarction, angina, coronary angioplasty, and bypass grafting. Linear and Cox regression models adjusted for CHD risk factors were used to examine, respectively, associations between optimism, hostility, and HRV and between HRV and CHD risk. RESULTS: Final analyses included 2655 women. Although optimism was not associated with HRV, hostility was inversely associated with HRV 3 years later (SDANN: adjusted ß = -0.54; 95% CI = -0.97 to -0.11; SDNN: -0.49; 95% CI = -0.93 to -0.05). HRV was inversely associated with CHD risk; for each 10-millisecond increase in SDNN or SDANN, there was a decrease in CHD risk of 9% (p = .023) and 12% (p = .006), respectively. CONCLUSIONS: HRV did not play a major role in explaining why more optimistic women seem to be somewhat protected from CHD risk. Although hostility was inversely associated with HRV, its role in explaining the association between hostility and CHD risk remains to be established.


Asunto(s)
Envejecimiento , Enfermedad Coronaria , Hostilidad , Optimismo , Personalidad , Anciano , Envejecimiento/fisiología , Envejecimiento/psicología , Enfermedad Coronaria/epidemiología , Enfermedad Coronaria/fisiopatología , Enfermedad Coronaria/psicología , Femenino , Humanos , Persona de Mediana Edad , Optimismo/psicología , Personalidad/fisiología , Estudios Prospectivos , Factores de Riesgo
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