Series Of Case Vignettes Research Articles

Diversity in the clinical presentation of generalized pustular psoriasis (GPP): A series of case vignettes from around the world.

A key principle of clinical studies and case reports is that they should reflect the demographics and epidemiology of the patient population concerned. Here, we have compiled a diverse group of clinical cases of generalized pustular psoriasis (GPP) to showcase the differences in GPP presentation in patients worldwide. We attempt to capture the broad spectrum of clinical presentations of GPP and showcase the diversity of the patient population. The patients included in this series are diverse in age, genetic background, skin phototype and medical history. Moreover, they present with a variety of clinical courses of GPP and different degrees of systemic involvement, and experience flares triggered by different inciting factors. The key learnings from this case series may support physicians in identifying and managing patients with this rare and multifaceted disease that can affect patients both physically and psychologically.

International servitization: theoretical roots, research gaps and implications

PurposeWhile the servitization concept has gained increasing attention in the domestic marketing literature, there is more limited knowledge with respect to its implications within the international context. The purpose of this paper is to examine the servitization concept in the international context considering its boundary conditions and its effects on firm performance. Relying on the resource-based view and the boundary conditions function, the authors aim to identify a set of research gaps focusing on how strategic resource decisions (i.e. slack resources and digital marketing capabilities) help industrial firms to provide different types of service offerings (i.e. services in support of product (SSPs) and services in support of client's actions (SSCs)) that leverage their performance in international markets.Design/methodology/approachThe authors illustrate international servitization strategies and the boundaries of servitization activities that firms employ through a series of case vignettes. The authors derive a conceptual framework, serving as a guideline for future research endeavors.FindingsThe authors indicate the importance of servitization strategies in international markets and identify eight research gaps, which help to build an agenda for future research. Key differences between international servitization strategies and strategic resource decisions are addressed through illustrative case vignettes from different industries.Practical implicationsThe insights from this work inform marketing executives about how international servitization strategies are influential in the context of overseas markets by characterizing the servitization concept and elaborating upon the specific resources and capabilities that underpin its execution in foreign markets.Originality/valueThis conceptual paper provides a comprehensive understanding of international servitization strategies in overseas markets and identifies several research paths that contribute to the complex nature of servitization in the international context and help scholars spot gaps and research questions worthy of investigation.

Can Social Workers Forecast Future Actions, Events, and Outcomes? A Study of Referrals to Children’s Services in England

ABSTRACT Child protection social workers in England are required to make many decisions in their day-to-day work, including whether to accept a referral, undertake a child protection investigation, pursue care proceedings, or close the case. Many of these decisions involve implicit or explicit predictions about the likelihood of future actions, events, and outcomes. This paper presents the results of a study in which social workers and social work students in England were asked at two time points, six to eight months apart, to read a series of case vignettes and make forecasts about the likelihood of different actions, events, and outcomes. The accuracy of these forecasts was measured to determine (1) the aggregate level and range of forecasting accuracy, (2) whether forecasting accuracy is stable over time, (3) whether different vignettes are harder or easier to forecast and (4) whether personal or professional factors are predictors of forecasting accuracy. On average, respondent’s forecasts were 6% better than you would expect by chance, although there was significant variation within the sample. Nearly three-quarters of the respondents who made forecasts more accurately than chance at Time 1 did so again at Time 2. Four of the vignettes were found to be consistently easier to forecast, and four were consistently more difficult. No personal or professional characteristics were found to be significant predictors of forecasting accuracy. There are few straight-forward decisions in social work and the question of how best to support practitioners as they undertake this critical aspect of their role will continue to be an important focus for research.

Racial implicit bias among obstetricians and midwives, and information on Down syndrome screening

Abstract Background and objectives Previous studies showed disparities in prenatal screening for Down syndrome according to the maternal place of birth. Among the factors that might be involved in these differences, social cognition offers the concept of implicit bias (IB) used to describe the fact of having attitudes towards people or associating stereotypes with them without necessarily conscious knowledge. In line with theoretical and empirical contributions in social psychology that postulate and demonstrate the role of automatic processes in determining behavior, IBs often predict how individuals behave more accurately than conscious values. The existence of IB among health professionals has been demonstrated in emergency care or pain management. To our knowledge, no study of IB has been conducted in Europe, nor in the field of perinatal care. Thus, our objectives were to test for IBs towards African women in terms of evaluation (negative bias) and strength (positive bias) among perinatal health professionals and test whether these IBs predicted treatment recommendations toward African vs. French patients. Methods Through online data collection, 887 perinatal care practicians (obstetrician-gynecologists, midwives) answered a series of case vignettes depicting African vs. French patients, with one specific to a Down syndrome screening situation. Then, participants completed two Implicit Association Tests to assess valence and strength IBs toward African vs. French women. Results 81.3% of the sample showed an implicit evaluative preference for French over African women, and 60.2% had an implicit perception of African women as stronger than French. However, decision toward Down syndrome screening were not influenced by the patient's origin nor by the healthcare professional implicit bias. Conclusions Perinatal practicians seem to have implicit biases toward African women, but the way they provide information regarding Down Syndrome screening is not affected.

Heightening our vigilance towards patient well-being

Objective Audiology patients frequently experience psychosocial difficulties created by their hearing loss or exacerbated by the loss. Clinicians are not always attuned to the unstated emotional undercurrents which may signal a need for further discussion or referral. This article aims to heighten audiologists’ vigilance towards patient well-being. Design A series of case vignettes with sample dialogue demonstrate the need for heightened clinical awareness of confounding consequences patients may grapple with and possible responses to these issues. Conclusions Beyond hearing loss, contributing detractors to patient well-being can be difficult to recognise for clinicians, and exploration and discussions may feel challenging to broach. A heightened vigilance within patient care calls upon audiologists to be alert for concerns or conditions beyond hearing loss that may be threatening our patients or further decreasing the quality of their lives and that of their families.

Three-Dimensional Cinematic Rendering to Optimize Visualization of Cerebrovascular Anatomy and Disease in CT Angiography.

Three-dimensional cinematic rendering (3DCR) is an emerging postprocessing technique for computed tomography (CT) and CT angiography (CTA) that produces photorealistic, volumetric images. In contrast to conventional volume rendering techniques, 3DCR depicts life-like shadowing and surface reflection, which can improve the perception of depth and complex anatomic spatial relationships. This tool allows clinical neuroimagers to study, explore, and teach the complex relational anatomy of the cerebral vessels and skull in a more intuitive manner. The purpose of this report is to introduce the physical and optical principles behind 3DCR and to explore applications of 3DCR in modern cerebrovascular imaging. Using CTA source data, we describe our approach to visualizing cerebrovascular anatomy and disease and introduce three simple, reproducible techniques through a series of case vignettes. First, we show how selective manipulation of rendered models can imitate cadaveric dissection. Next, we discuss surface rendering as a means of recapitulating the neurologic physical exam. Last, we provide a step-by-step method of simulating the operating room perspective in visualizing cerebrovascular disease. In our experience, 3DCR proves most useful for visualizing structures at the vessel-skull interface, which can be difficult to assess with conventional imaging methods. 3DCR, therefore, complements traditional 2-dimensional and 3-dimensional imaging methods and serves as an emerging tool for neuroimagers to communicate with and educate other clinicians.

FAMILY MATTERS: CULTURAL PROFICIENCY IN THE PRESENT DAY

Introduction The United States is projected to have over 78 million people over the age of 65 by the year 2035, with an increasing rise in culturally, ethnically, and racially diverse population largely driven by international immigration. An important aspect of assessment and treatment in geriatric psychiatry is the ability to include family members into evaluations and treatment plans. Cultural sensitivity about beliefs, traditions, and perceptions on aging and mental illness play an important role in understanding and treating psychiatric disorders and increases the probability of a therapeutic relationship by enhancing trust and improving communication between clinicians and patients. Although there is mention of “family” and “sociocultural” in all six ACGME core competencies, these are not explicitly expanded upon. With the changing demographics in the US in the years to come, it is imperative to recognize and incorporate more elements of family and culture into training. Methods Demonstrate, through a series of case vignettes, the impact of addressing cultural expectations and context with family members and patients to improve clinical outcomes. Personal factors of race and ethnicity, along with cultural biases, will be identified to show how these factors influence the therapeutic alliance and interventions. Results These vignettes illustrate how establishing a sense of cultural safety allowed both the families and patients to collaborate more openly with the treatment team to provide effective therapeutic outcomes for culturally diverse older adults. Recognition and understanding of how culture influences family dynamics, beliefs, and support systems allowed trainees to more comprehensively understand the cultural formulation and guide treatments that were more culturally sensitive and pertinent to various psychiatric disorders. Conclusions In depth training during psychiatry residency regarding family and culture are often lacking, especially since the ACGME requirements for training related to diversity and culture are broad and not explicitly stated. By recognizing the important role that families and culture play in the treatment of older adults, residents can more easily address sensitive issues that affect treatment outcomes. As such, training programs should have more detailed didactics and curriculum to help residents feel more comfortable sitting with and including families, as well as understanding and acknowledging how culture influences the care of diverse older adults.

Diagnosis and Management of Immune Checkpoint Inhibitor–related Toxicities in Ovarian Cancer: A Series of Case Vignettes

Use of immune checkpoint inhibitors targeting cytotoxic T-lymphocyte-associated antigen 4 and programmed cell death protein 1 have led to improved survival outcomes for advanced solid-tumor malignancies. This report helps the reader gain a better understanding of adverse events in patients with ovarian cancer on checkpoint inhibitor therapy. We describe 3 hypothetical case vignettes of patients with gynecologic cancer on checkpoint inhibitor immunotherapy and discuss common immune-related adverse events. The typical presentation and onset of immune-related events are different from those associated with conventional chemotherapy. This report highlights the importance of early recognition and management of these events.

Acceptability and Reliability of a Novel Palliative Care Screening Tool Among Emergency Department Providers.

The Palliative Care and Rapid Emergency Screening (P-CaRES) Project is an initiative intended to improve access to palliative care (PC) among emergency department (ED) patients with life-limiting illness by facilitating early referral for inpatient PC consultations. In the previous two phases of this project, we derived and validated a novel PC screening tool. This paper reports on the third and final preimplementation phase. Examine the acceptability of the P-CaRES tool among PC and ED providers as well as test its reliability on case vignettes. Compare variations in reliability and acceptability of the tool based on ED providers' roles (attendings, residents, and nurses) and lengths of experience. A two-part electronic survey was distributed to ED providers at multiple sites across the United States. We tested the reliability of the tool in the first part of the survey, through a series of case vignettes. A criterion standard of correct responses was first defined by consensus input from expert PC physicians' interpretations of the vignettes. The experts' input was validated using the Gwet's AC1 coefficient for inter-rater reliability. ED providers were then presented with the case vignettes and asked to use the P-CaRES tool to correctly identify which patients had unmet PC needs. ED provider responses were compared both against the criterion standard and against different subsets of respondents (divided both by role and by level of experience). The second part of the survey assessed acceptability of the P-CaRES tool among ED providers using responses to questions from a modified Ottawa Acceptability of Decision Rules Instrument, based on a 1-5 Likert rating scale. Descriptive statistics were used to report all outcomes. In total, 213 ED providers employed in three different regions across the country responded to the survey (39.4%) and 185 (86.9%) of those completed it. The majority of providers felt that the tool would be useful in their practice (80.5%), agreed that the tool was clear and unambiguous (87.1%), thought that use of the tool would likely benefit patients (87.5%), and thought that it would result in improved use of resources to help severely ill patients (83.6%). Over three-quarters of ED providers (78.5%) also self-reported that they refer patients with unmet PC needs less than 10% of the time, and only 10.8% of respondents believed that they are already utilizing an effective strategy to screen or refer patients to PC. Applying our P-CaRES tool to case vignettes, ED providers generated PC referrals in concordance with PC experts over 88.7% of the time (95% confidence interval = 86.4% to 90.6%), with an overall sensitivity of more than 90%. These results varied minimally regardless of the respondent's role in the ED or their level of experience. Screening by emergency medicine providers for unmet PC needs using a brief, novel, content-validated screening tool is acceptable and is also reliable when applied to case vignettes-regardless of provider role or experience. Clinical trial and further study are warranted and are currently under way.

The AMBIT approach: working with hard to reach youth

Purpose – MBIT is a manualised mentalization-based approach to working with hard to reach young people at risk of a wide range of life adversities including severe mental illness, substance misuse, family breakdown, school exclusion, offending and homelessness. The on-line manual (www.tiddlymanuals.com) describes how Adolescent Mentalization-Based Integrative Therapy (AMBIT) is a systemic intervention requiring attention to four different domains of intervention simultaneously; much emphasis is placed on the support systems for workers to maintain this balance in what are often chaotic working conditions. The purpose of this paper is to illustrate how these four main components of the AMBIT approach link together in actual clinical practice. Design/methodology/approach – The authors illustrate the core techniques of the AMBIT approach, namely, “working with your client”, “working with your team”, “ working with your network” and “learning as a team” with a series of case vignettes, demonstrating the inter-relationship of these components rather than seeing them as separate strands. Findings – A range of mentalization-based techniques such as “thinking together”, mentalized formulation, “disintegration grids” and web-based manualising are described and illustrated in relation to a series of case vignettes in order to address barriers to effective practice. The vignettes emphasise how these components must be linked together and held in balance, and how easily they become disconnected in working with young people’s ambivalent or even hostile relationships to help. Practical implications – First, developing a shared, mentalized formulation of a young person’s difficulties is an important aspect of working with highly troubled young people. Second, mentalizing is a relational process and is easily disrupted, for both workers and young people, by raised anxiety and affect, a common feature of working with this client group. AMBIT provides specific methods, for example, “thinking together” for supporting the mentalizing of individual workers in their team in an explicit way. Third, workers from different agencies may often find it difficult to make sense of each other’s behaviour and decision making. AMBIT proposes the use of a mentalizing approach to this difficulty using a technique called a disintegration grid. Finally, AMBIT proposes a new practitioner focused approach to manualising as a method by which a team can become more explicit about its methods of working in order to support systematic practice and evaluate outcomes. Originality/value – The innovative AMBIT approach proposes that clinicians need to attend to team and network relationships at least as much as their relationship with the client, in addition to adopting a stance of learning as a team from their casework. A high level of clinical skill is needed to support a team to achieve this balanced approach to casework. This work is of interest to all multi-disciplinary teams working with hard to reach young people.

Canaries in the Ethical Coal Mine? Case Vignettes and Empirical Findings for How Psychology Leaders Have Adopted Twitter

Twitter, an online application, allows users to post microblog statements in real time. Have psychologists in leadership positions adopted Twitter? What ethical standards are navigated in doing so? Little research has examined the adoption rate of Twitter within a sample of psychologists. This article outlines a series of case vignettes depicting ethical dilemmas encountered by psychologists who adopt Twitter. Data reviewing Twitter adoption by professional psychologists who served as president within psychology advocacy organizations reveal higher adoption rates from student group leaders than professional organization advocacy presidents. Implications for ethical standards and professional development are discussed.

Risk assessment and decision making regarding imminent suicidality in pediatric settings.

Risk assessment for suicidality and related clinical decision making raises a number of ethical, clinical, and professional challenges for pediatric psychologists across the many clinical settings and professional roles in which these risk assessments may be conducted. Prior work has focused on ethical issues related to imminent risk concerns and the development of risk assessment protocols for use in clinical work or research. However, little work has attended to the real-world clinical scenarios in which risk assessment occurs, specifically within pediatric settings, and the unique clinical decision-making dilemmas faced by pediatric psychologists in these risk assessment scenarios. After a review of the ethical, clinical, and professional challenges often faced by pediatric psychologists in evaluating and addressing imminent risk among youth, a series of case vignettes is presented to illustrate these challenges and the clinical decision-making skills utilized to resolve such challenges.

The pediatric surgeon and palliative care

Palliative care is now a core component of pediatric care for children and families who are confronting serious illness with a low likelihood of survival. Pediatric surgeons, in partnership with pediatric palliative care teams, can play a pivotal role in assuring that these patients receive the highest possible quality of care. This article outlines a variety of definitions and conceptual frameworks, describes decision-making strategies and communication techniques, addresses issues of interdisciplinary collaboration and personal self-awareness, and illustrates these points through a series of case vignettes, all of which can help the pediatric surgeon perform the core tasks of pediatric palliative care.

P02-242 - Mental health of older people: the role of primary care

There are currently over 600 million people aged over 60 and it is predicted that, by 2025, the number will double and, by 2050 there will be over 2 billion people aged 60 and above and the number of over 60's will be greater than the number of children under the age of 15. Co-morbid physical and mental health conditions are associated with an aging population and many of this population will suffer from stroke, hypertension, loneliness, depression, dementia, mobility and sight problems. The traditional approach of caring for people in hospitals is increasingly inappropriate for many of the elderly population and primary care is often the first point of contact for many people seeking access to health and social care. In 2008, the WHO and Wonca (World Organisation of Family Doctors) published a document about the integration of mental health into primary care across spectrum. We will be describing the principles and method of integration of mental health problems in old age into primary care using examples from the Australian and UK setting. Also we will examine the role non-governmental organisations can play in the process of integration. Caring for the elderly is rewarding and possible in the primary care setting. The current situation where many elderly people do not have access to an integrated health care system is unacceptable. Using data and a series of case vignettes we will illustrate that primary care has an important role to play within an integrated system.

A CONSTRUCTIVIST APPROACH TO SEX THERAPY WITH COUPLES

Couple therapists benefit from having knowledge about sexuality and how it influences the couple relationship. Traditional couple therapy often focuses on relational issues while ignoring the sexual components of the relationship. Traditional sex therapy techniques often focus on the behavioral aspects of sexual difficulties while ignoring their underlying sexual meanings. This article presents a systemic-constructivist approach to integrative sexual and couple psychotherapy that encourages in-depth exploration of sexual meanings and their impact on the couple relationship. The concepts of holonic sex therapy developed by Rubio (1983), which focuses on four main aspects of sexuality (gender, eroticism, interpersonal bonding, and reproductivity holons), are presented as ways of mapping problematic sexual meanings, in a way that permits their integration with other constructivist approaches to therapy. A series of case vignettes is offered to exemplify this holonic perspective.

Chronic Illness During Childhood and Adolescence: Psychological Aspects

Chronic Illness During Childhood and Adolescence: Psychological Aspects is a well-written and concise monograph from the Sage series, summarizing the current knowledge of the field. The Sage Series in Developmental Clinical Psychology and Psychiatry addresses a variety of topics from a multidisciplinary viewpoint, focusing on contemporary theory and research. The material covered in this work is most relevant to health care providers in pediatrics, child psychology, child psychiatry, nursing, and social work. The monograph begins with a series of case vignettes, accompanied by individual commentaries. The cases chosen for discussion illustrate common and often frustrating problems encountered in the care of children with chronic diseases. The commentaries are thoughtful and thought provoking. An overview of childhood chronic diseases is provided in the second section, beginning with a historical perspective and contemporary incidence and prevalence patterns. More specific information concerning prevalence, incidence, natural history, and developmental and psychological correlates are provided