An introduction to the special section on the Capability Approach to career guidance.

This editorial introduces readers to the Capability Approach to career guidance. It outlines the origins of the approach in the work of economist Amartya Sen, and explains some of its key concepts. The Capability Approach offers a way to think about freedom, justice and well-being that has great relevance to the concerns of career guidance. A brief summary is provided of scholarship adapting the Capability Approach for application to career research, policy and practice. Finally, the four papers in the special section (Egdell & Robertson; Joncas & Pilote; Skovhus; Fuertes et al.) are introduced.

Éditorial: Introduction à la section spéciale sur l'approche par les capabilités appliquée au développement de carrière L'approche par les capabilités, qui a fait une percée dans le domaine du développement de carrière, tire son origine des travaux de l'économiste Amartya Sen. Elle renvoie à une idée de justice, ainsi qu'à une façon de concevoir la liberté et le bien-être des individus qui sont au cœur des enjeux en développement de carrière. Avant de présenter les contributions des auteures et auteurs, il importe de définir les concepts-clés de l'approche par les capabilités, ainsi que d'en illustrer l'utilisation tant en recherche, en intervention que dans les politiques liées au développement de carrière, à l'aide de quelques exemples. Quatre articles ont été retenus dans cette section spéciale, à savoir : Egdell & Robertson; Joncas & Pilote; Skovhus; Fuertes et al.

Introducción a la sección extraordinaria sobre el Enfoque de las Capacidades aplicado a la orientación para el desarrollo de la carrera Esta editorial presenta a los lectores el Enfoque de las Capacidades aplicado a la orientación para el desarrollo de la carrera. Esboza los orígenes del enfoque a partir del trabajo de la economista Amartya Sen, y explica algunos de sus conceptos clave. El Enfoque de las Capacidades proporciona una forma de concebir la libertad, la justicia y el bienestar que tiene gran relevancia para las cuestiones relacionadas con orientación para el desarrollo de la carrera. Se aporta un breve resumen de los estudios que adaptan el Enfoque de las Capacidades para su aplicación a la investigación, las políticas y la práctica sobre el desarrollo de la carrera. Por último, se presentan los cuatro artículos de la sección extraordinaria (Egdell & Robertson; Joncas & Pilote; Skovhus; Fuertes et al.).

Career guidance and active labour market policies in the Republic of Armenia.

This article provides an account of current public policy for career guidance in the Republic of Armenia. Brief background information is provided in terms of key geographical, political, social and economic facts about Armenia. Then, a more specific context is outlined with a brief overview of the education and skills system and of the labour market environment. Career guidance in Armenia needs to be understood in relation to recent public policy initiatives to introduce active labour market programmes. The scope of these programmes is outlined and a critique of current policy is provided. Finally, priorities for future development are considered.

Orientation professionnelle et politiques actives du marché du travail en République d'Arménie Cet article rend compte de la politique publique actuelle en matière d'orientation professionnelle dans la République d'Arménie. De brèves informations générales sont fournies en termes de faits-clé concernant l'Arménie d'un point de vue géographie, politique, social et économique. Ensuite, un contexte plus spécifique est décrit, avec un bref aperçu du système d'éducation et de compétences ainsi que du marché du travail. L'orientation professionnelle en Arménie doit être comprise en relation avec les récentes initiatives d'introductions de programmes de politique publique active du marché du travail. Le champ d'application de ces programmes est décrit et une critique de la politique actuelle est fournie. Finalement, les priorités pour le développement futur sont examinées.

Orientación profesional y políticas activas del mercado laboral en la República de Armenia Este analiza las políticas públicas actuales de orientación profesional en la República de Armenia. Se exponen una breve información sobre los antecedentes, en términos de hechos geográficos, políticos, sociales y económicos clave sobre Armenia. A continuación se describe un contexto más específico con una breve revisión del contexto del sistema educativo y de competencias así como del mercado laboral. La orientación profesional en Armenia debe entenderse en relación con las recientes iniciativas de políticas públicas para introducir planes activos planes activos de empleo. Se describe el alcance de estos programas y se ofrece una visión crítica de la política actual. Finalmente, se consideran prioridades para el desarrollo futuro.

Clinical practice guideline: acute otitis externa executive summary.

The American Academy of Otolaryngology--Head and Neck Surgery Foundation (AAO-HNSF) has published a supplement to this issue featuring the updated Clinical Practice Guideline: Acute Otitis Externa, as a supplement to Otolaryngology-Head and Neck Surgery. To assist in implementing the guideline recommendations, this article summarizes the rationale, purpose, and key action statements. The 8 recommendations developed address appropriate diagnosis of acute otitis externa (AOE) and the use of oral and topical antimicrobials and highlight the need for adequate pain relief. An updated guideline is needed due to new clinical trials, new systematic reviews, and the lack of consumer participation in the initial guideline development group.

Clinical practice guideline: acute otitis externa.

OBJECTIVE: This clinical practice guideline is an update and replacement for an earlier guideline published in 2006 by the American Academy of Otolaryngology-Head and Neck Surgery Foundation. This update provides evidence-based recommendations to manage acute otitis externa (AOE), defined as diffuse inflammation of the external ear canal, which may also involve the pinna or tympanic membrane. The variations in management of AOE and the importance of accurate diagnosis suggest a need for updating the clinical practice guideline. The primary outcome considered in this guideline is clinical resolution of AOE. PURPOSE: The primary purpose of the original guideline was to promote appropriate use of oral and topical antimicrobials for AOE and to highlight the need for adequate pain relief. An updated guideline is needed because of new clinical trials, new systematic reviews, and the lack of consumer participation in the initial guideline development group. The target patient is aged 2 years or older with diffuse AOE. Differential diagnosis will be discussed, but recommendations for management will be limited to diffuse AOE, which is almost exclusively a bacterial infection. This guideline is intended for primary care and specialist clinicians, including otolaryngologists-head and neck surgeons, pediatricians, family physicians, emergency physicians, internists, nurse practitioners, and physician assistants. This guideline is applicable in any setting in which patients with diffuse AOE would be identified, monitored, or managed. ACTION STATEMENTS: The development group made strong recommendations that (1) clinicians should assess patients with AOE for pain and recommend analgesic treatment based on the severity of pain and (2) clinicians should not prescribe systemic antimicrobials as initial therapy for diffuse, uncomplicated AOE unless there is extension outside the ear canal or the presence of specific host factors that would indicate a need for systemic therapy. The development group made recommendations that (1) clinicians should distinguish diffuse AOE from other causes of otalgia, otorrhea, and inflammation of the external ear canal; (2) clinicians should assess the patient with diffuse AOE for factors that modify management (nonintact tympanic membrane, tympanostomy tube, diabetes, immunocompromised state, prior radiotherapy); (3) clinicians should prescribe topical preparations for initial therapy of diffuse, uncomplicated AOE; (4) clinicians should enhance the delivery of topical drops by informing the patient how to administer topical drops and by performing aural toilet, placing a wick, or both, when the ear canal is obstructed; (5) clinicians should prescribe a non-ototoxic preparation when the patient has a known or suspected perforation of the tympanic membrane, including a tympanostomy tube; and (6) clinicians should reassess the patient who fails to respond to the initial therapeutic option within 48 to 72 hours [corrected] to confirm the diagnosis of diffuse AOE and to exclude other causes of illness.

The well-being outcomes of career guidance.

The potential for career guidance to impact on well-being has received insufficient attention in the UK. There are both conceptual and empirical reasons to expect that the impacts may be positive, but a lack of evidence directly testing this proposition. Career guidance has commonalities with therapeutic counselling suggesting analogous effects, and it promotes positive engagement in work and learning, which may be associated with health benefits. There are implications for services in reconciling health and employment objectives. However, the promotion of well-being need not imply quasi-clinical ways of working. A call is made for more research and debate in the career guidance community as to the extent and implications of the potentially important relationship between career guidance and well-being.

Clinical practice guideline: improving voice outcomes after thyroid surgery.

OBJECTIVE: Thyroidectomy may be performed for clinical indications that include malignancy, benign nodules or cysts, suspicious findings on fine needle aspiration biopsy, dysphagia from cervical esophageal compression, or dyspnea from airway compression. About 1 in 10 patients experience temporary laryngeal nerve injury after surgery, with longer lasting voice problems in up to 1 in 25. Reduced quality of life after thyroid surgery is multifactorial and may include the need for lifelong medication, thyroid suppression, radioactive scanning/treatment, temporary and permanent hypoparathyroidism, temporary or permanent dysphonia postoperatively, and dysphagia. This clinical practice guideline provides evidence-based recommendations for management of the patient's voice when undergoing thyroid surgery during the preoperative, intraoperative, and postoperative period. PURPOSE: The purpose of this guideline is to optimize voice outcomes for adult patients aged 18 years or older after thyroid surgery. The target audience is any clinician involved in managing such patients, which includes but may not be limited to otolaryngologists, general surgeons, endocrinologists, internists, speech-language pathologists, family physicians and other primary care providers, anesthesiologists, nurses, and others who manage patients with thyroid/voice issues. The guideline applies to any setting in which clinicians may interact with patients before, during, or after thyroid surgery. Children under age 18 years are specifically excluded from the target population; however, the panel understands that many of the findings may be applicable to this population. Also excluded are patients undergoing concurrent laryngectomy. Although this guideline is limited to thyroidectomy, some of the recommendations may extrapolate to parathyroidectomy as well. RESULTS: The guideline development group made a strong recommendation that the surgeon should identify the recurrent laryngeal nerve(s) during thyroid surgery. The group made recommendations that the clinician or surgeon should (1) document assessment of the patient's voice once a decision has been made to proceed with thyroid surgery; (2) examine vocal fold mobility, or refer the patient to a clinician who can examine vocal fold mobility, if the patient's voice is impaired and a decision has been made to proceed with thyroid surgery; (3) examine vocal fold mobility, or refer the patient to a clinician who can examine vocal fold mobility, once a decision has been made to proceed with thyroid surgery if the patient's voice is normal and the patient has (a) thyroid cancer with suspected extrathyroidal extension, or (b) prior neck surgery that increases the risk of laryngeal nerve injury (carotid endarterectomy, anterior approach to the cervical spine, cervical esophagectomy, and prior thyroid or parathyroid surgery), or (c) both; (4) educate the patient about the potential impact of thyroid surgery on voice once a decision has been made to proceed with thyroid surgery; (5) inform the anesthesiologist of the results of abnormal preoperative laryngeal assessment in patients who have had laryngoscopy prior to thyroid surgery; (6) take steps to preserve the external branch of the surperior laryngeal nerve(s) when performing thyroid surgery; (7) document whether there has been a change in voice between 2 weeks and 2 months following thyroid surgery; (8) examine vocal fold mobility or refer the patient for examination of vocal fold mobility in patients with a change in voice following thyroid surgery; (9) refer a patient to an otolaryngologist when abnormal vocal fold mobility is identified after thyroid surgery; (10) counsel patients with voice change or abnormal vocal fold mobility after thyroid surgery on options for voice rehabilitation. The group made an option that the surgeon or his or her designee may monitor laryngeal electromyography during thyroid surgery. The group made no recommendation regarding the impact of a single intraoperative dose of intravenous corticosteroid on voice outcomes in patients undergoing thyroid surgery.

Choosing wisely: our list.

In February 2013, the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) released its list of 5 recommendations of diagnostic and therapeutic interventions that physicians and patients should question, as part of the American Board of Internal Medicine (ABIM) Foundation's Choosing Wisely campaign. This commentary outlines the impetus for the AAO-HNSF to join the campaign, our list of 5 recommendations, how they were developed, and our future involvement with the campaign. The AAO-HNSF's 5 recommendations are (1) don't order a computed tomography (CT) scan of the head/brain for sudden hearing loss, (2) don't prescribe oral antibiotics for uncomplicated acute tympanostomy tube otorrhea, (3) don't prescribe oral antibiotics for uncomplicated acute external otitis, (4) don't routinely obtain radiographic imaging for patients who meet diagnostic criteria for uncomplicated acute rhinosinusitis, and (5) don't obtain CT or magnetic resonance imaging in patients with a primary complaint of hoarseness prior to examining the larynx.

Clinical practice guideline: sudden hearing loss.

OBJECTIVE: Sudden hearing loss (SHL) is a frightening symptom that often prompts an urgent or emergent visit to a physician. This guideline provides evidence-based recommendations for the diagnosis, management, and follow-up of patients who present with SHL. The guideline primarily focuses on sudden sensorineural hearing loss (SSNHL) in adult patients (aged 18 and older). Prompt recognition and management of SSNHL may improve hearing recovery and patient quality of life (QOL). Sudden sensorineural hearing loss affects 5 to 20 per 100,000 population, with about 4000 new cases per year in the United States. This guideline is intended for all clinicians who diagnose or manage adult patients who present with SHL. PURPOSE: The purpose of this guideline is to provide clinicians with evidence-based recommendations in evaluating patients with SHL, with particular emphasis on managing SSNHL. The panel recognized that patients enter the health care system with SHL as a nonspecific, primary complaint. Therefore, the initial recommendations of the guideline deal with efficiently distinguishing SSNHL from other causes of SHL at the time of presentation. By focusing on opportunities for quality improvement, the guideline should improve diagnostic accuracy, facilitate prompt intervention, decrease variations in management, reduce unnecessary tests and imaging procedures, and improve hearing and rehabilitative outcomes for affected patients. RESULTS: The panel made strong recommendations that clinicians should (1) distinguish sensorineural hearing loss from conductive hearing loss in a patient presenting with SHL; (2) educate patients with idiopathic sudden sensorineural hearing loss (ISSNHL) about the natural history of the condition, the benefits and risks of medical interventions, and the limitations of existing evidence regarding efficacy; and (3) counsel patients with incomplete recovery of hearing about the possible benefits of amplification and hearing-assistive technology and other supportive measures. The panel made recommendations that clinicians should (1) assess patients with presumptive SSNHL for bilateral SHL, recurrent episodes of SHL, or focal neurologic findings; (2) diagnose presumptive ISSNHL if audiometry confirms a 30-dB hearing loss at 3 consecutive frequencies and an underlying condition cannot be identified by history and physical examination; (3) evaluate patients with ISSNHL for retrocochlear pathology by obtaining magnetic resonance imaging, auditory brainstem response, or audiometric follow-up; (4) offer intratympanic steroid perfusion when patients have incomplete recovery from ISSNHL after failure of initial management; and (5) obtain follow-up audiometric evaluation within 6 months of diagnosis for patients with ISSNHL. The panel offered as options that clinicians may offer (1) corticosteroids as initial therapy to patients with ISSNHL and (2) hyperbaric oxygen therapy within 3 months of diagnosis of ISSNHL. The panel made a recommendation against clinicians routinely prescribing antivirals, thrombolytics, vasodilators, vasoactive substances, or antioxidants to patients with ISSNHL. The panel made strong recommendations against clinicians (1) ordering computerized tomography of the head/brain in the initial evaluation of a patient with presumptive SSNHL and (2) obtaining routine laboratory tests in patients with ISSNHL.