Developing Antiracist Social Work Practice at a Comprehensive Cancer Center.

The combination of the ongoing violence perpetuated against Black, Brown, and Asian people, and the increased incidence of death of Black, Indigenous, people of color (BIPOC) and Asian Americans and Pacific Islanders (AAPI) at the start of the COVID-19 pandemic, elicited an important response from the field of social work across the nation. This article describes the efforts undertaken by a Social Work Department at a comprehensive cancer center in response to a call to develop antiracist practice. This article recounts the process of creating educational opportunities for oncology social workers to help them identify bias and racism in themselves and throughout the healthcare system, to embrace intentional antiracist practice, and to better advocate for BIPOC/AAPI patients and colleagues. The strategies included the development of an antiracism committee, the use of a social location exercise to influence and disrupt white supremacy, the creation of community guidelines for engaging in conversations about race, and the formulation of a new departmental policy ensuring a commitment to antiracist social work practice. In addition, a forum using multimedia was created to explore racial dynamics and to highlight the narratives of BIPOC and AAPI people. Further, a monthly Antiracist Clinical Case Conference was implemented to explore their role in the context of working with the interdisciplinary team in an oncology setting. This article concludes with recommendations for ongoing antiracist social work practice development that may be applied in various healthcare settings.

Late Complication of Quadricuspid Aortic Valve: Early Moderate to Severe Aortic Regurgitation.

Quadricuspid aortic valve (QAV) is a rare congenital cardiac anomaly. A normal aortic valve has three cusps, but cases of unicuspid, bicuspid, and quadricuspid aortic valves have been reported. Although QAV usually appears as an isolated congenital anomaly, it may also be associated with other heart conditions. In comparison to the bicuspid aortic valve (BAV) that results in aortic stenosis by the early 50s due to age-related early calcification, this case series suggests that patients with QAV are likely to develop moderate to severe aortic regurgitation in their late 40s or early 50s. Most patients with QAV require tricuspidalization, which is the preferred method for QAV surgical repair, especially in patients with associated aortic regurgitation. The condition was previously diagnosed intraoperatively or postpartum. Today, with imaging modalities like transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), and cardiac magnetic resonance imaging, more cases of QAV have been diagnosed in asymptomatic individuals. We present a case series of a previously healthy 49-year-old male and a 47-year-old female who had similar presentations of acute congestive heart failure (CHF). An echocardiogram confirmed that both patients had heart failure with reduced ejection fraction, dilated cardiomyopathy, QAV, and moderate to severe aortic valve regurgitation on echocardiogram. The male patient had an ejection fraction (EF) of 30-35% and a QAV with partial fusion of the leaflets, resulting in a functionally bicuspid aortic valve, while the female patient had an EF of 25-30% with what appears to be a type III QAV according to Nakamura et al. classification. The purpose of this case series is to highlight another potential late complication of congenital QAV.

Constructing indirect utility models: some observations on the principles and practice of mapping to obtain health state utilities.

The construction of mapping models is an increasingly popular mechanism for obtaining health state utility data to inform economic evaluations in health care. There is great variation in the sophistication of the methods utilized but to date very little discussion of the appropriate theoretical framework to guide the design and evaluation of these models. In this paper, we argue that recognizing mapping models as a form of indirect health state valuation allows the use of the framework described by Dolan for the measurement of social preferences over health. Using this framework, we identify substantial concerns with the method for valuing health states that is implicit in indirect utility models (IUMs), the conflation of two sets of respondents' values in such models, and the lack of a structured and statistically reasonable approach to choosing which states to value and how many observations per state to require in the estimation dataset. We also identify additional statistical challenges associated with clustering and censoring in the datasets for IUMs, additional to those attributable to the descriptive systems, and a potentially significant problem with the systematic understatement of uncertainty in predictions from IUMs. Whilst recognizing that IUMs appear to meet the needs of reimbursement organizations that use quality-adjusted life years in their appraisal processes, we argue that current proposed quality standards are inadequate and that IUMs are neither robust nor appropriate mechanisms for estimating utilities for use in cost-effectiveness analyses.