Godspeed: Counselor Education Doctoral Student Experiences From Diverse Religious and Spiritual Backgrounds

Amidst growing literature regarding the importance of spirituality within counseling and counselor education, little is known of the experiences of doctoral students regarding their religious and spiritual backgrounds while matriculating through their doctoral program. This research explored the experiences of four researcher-participant counselor education doctoral students from diverse religious and spiritual backgrounds. This exploration deepened their understanding of the role their religious and spiritual identities played in their thoughts, emotions, challenges, and strengths of their experiences. A phenomenological autoethnography method was used for this study. A unique data analysis procedure was developed called Integrative Group Process Phenomenology (IGPP), which was used to analyze journal and music data. The overarching experience was described as a journey with four primary categories of themes identified: painful experiences, learning and awareness, velocity (i.e., themes descriptive of movement and action), and connect versus disconnect. This research brought to light the challenges that counselor education doctoral students may encounter in their training, while highlighting the strength and resilience that religion and spirituality may offer. Recommendations, limitations, and implications for the counseling profession are offered to further the development of research regarding religious and spiritual experiences. © 2018: Alyse M. Anekstein, Lynn Bohecker, Tiffany Nielson, Hailey Martinez, and Nova Southeastern University

Bleeding and first-year mortality following hip fracture surgery and preoperative use of low-dose acetylsalicylic acid: an observational cohort study

<p>Abstract</p> <p>Background</p> <p>Hip fracture is associated with high mortality. Cardiovascular disease and other comorbidities requiring long-term anticoagulant medication are common in these mostly elderly patients. The objective of our observational cohort study of patients undergoing surgery for hip fracture was to study the association between preoperative use of low-dose acetylsalicylic acid (LdAA) and intraoperative blood loss, blood transfusion and first-year all-cause mortality.</p> <p>Methods</p> <p>An observational cohort study was conducted on patients with hip fracture (cervical requiring hemiarthroplasty or pertrochanteric or subtrochanteric requiring internal fixation) participating in a randomized trial that found lack of efficacy of a compression bandage in reducing postoperative bleeding. The participants were 255 patients (≥50 years) of whom 118 (46%) were using LdAA (defined as ≤320 mg daily) preoperatively. Bleeding variables in patients with and without LdAA treatment at time of fracture were measured and blood transfusions given were compared using logistic regression. The association between first-year mortality and preoperative use of LdAA was analyzed with Cox regression adjusting for age, sex, type of fracture, baseline renal dysfunction and baseline cardiovascular and/or cerebrovascular disease.</p> <p>Results</p> <p>Blood transfusions were given postoperatively to 74 (62.7%) LdAA-treated and 76 (54%) non-treated patients; the adjusted odds ratio was 1.8 (95% CI 1.04 to 3.3). First-year mortality was significantly higher in LdAA-treated patients; the adjusted hazard ratio (HR) was 2.35 (95% CI 1.23 to 4.49). The mortality was also higher with baseline cardiovascular and/or cerebrovascular disease, adjusted HR 2.78 (95% CI 1.31 to 5.88). Patients treated with LdAA preoperatively were significantly more likely to suffer thromboembolic events (5.7% vs. 0.7%, P = 0.03).</p> <p>Conclusions</p> <p>In patients with hip fracture (cervical treated with hemiarthroplasty or pertrochanteric or subtrochanteric treated with internal fixation) preoperative use of low-dose acetylsalicylic acid was associated with significantly increased need for postoperative blood transfusions and significantly higher all-cause mortality during one year after surgery.</p

Avaliação da redução por ligamentotaxia nas fraturas toracolombares tipo explosão Evaluación de la reducción por ligamentotaxia en las fracturas toracolumbares tipo explosión Evaluation of the reduction by ligamentotaxis in thoracolumbar burst fractures

OBJETIVO: avaliar a correção da cifose, da altura do corpo vertebral e da redução dos fragmentos retropulsados nas fraturas toracolombares tipo explosão por ligamentotaxia. MÉTODOS: estudo retrospectivo avaliando um total de 238 pacientes com fraturas toracolombares tipo explosão do grupo A3 pela classificação de Magerl et al., dos quais 63 deles elegíveis para a pesquisa. Todos foram tratados com fixador interno pedicular e tinham imagens radiográficas e tomográficas pré e pós-operatórias. RESULTADOS: No estudo, foi constatada, no pós-operatório imediato, uma correção da cifose vertebral no local da fratura de 87%, com correção de 51% na altura do corpo vertebral e redução de 40% dos fragmentos retropulsados intracanal. CONCLUSÕES: o uso de fixador interno por via posterior permite, ao realizar ligamentotaxia, a restauração da altura do corpo vertebral fraturado, do alinhamento sagital da coluna e descompressão do canal espinhal, minimizando as comorbidades em relação à cirurgia pela via anterior e à laminectomia para descompressão do canal.<br>OBJETIVO: evaluar la corrección de la cifosis, de la altura del cuerpo vertebral y de la reducción de los fragmentos retro pulsados en las fracturas toracolumbares tipo explosión por ligamentotaxia. MÉTODOS: estudio retrospectivo evaluando un total de 238 pacientes con fracturas toracolumbares tipo explosión del Grupo A3 por la clasificación de Magerl et al., de los cuales 63 de ellos fueron elegidos para la investigación. Todos fueron tratados con fijador interno pedicular y tenían imágenes radiográficas y de tomografías pre y postoperatorias. RESULTADOS: en el estudio, se constató en el postoperatorio inmediato una corrección de la cifosis vertebral en el local de la fractura de 87% con corrección de 51% en la altura del cuerpo vertebral, y una reducción de 40% de los fragmentos retro pulsados intracanal. CONCLUSIONES: el uso del fijador interno por vía posterior permite, al realizar ligamentotaxia, la restauración de la altura del cuerpo vertebral fracturado, del alineamiento sagital de la columna y descompresión del canal espinal minimizando la comorbidad en relación a la cirugía por vía anterior y la laminectomía para descompresión del canal.<br>OBJECTIVE: to evaluate the correction of kyphosis, of the vertebral body height and the reduction of the retropulsed fragments in the thoracolumbar burst fractures by means of ligamentotaxis. METHODS: retrospective study evaluating a total of 238 patients with thoracolumbar A3 burst fractures based on the classification by Magerl et al., of which 63 were eligible to the research. All patients had been treated with pedicular internal fixation and had previous and postoperative radiographs and computed tomographic images. RESULTS: the study evidenced an immediate postoperative correction of vertebral kyphosis in the fracture site in 87% of the cases, with correction of 51% in the vertebral body height and reduction of 40% the intra-canal retropulsed fragments. CONCLUSIONS: the use of internal fixation by anterior approach allows, through ligamentotaxis, the restoration of the height of the vertebral body fracture, of the sagittal alignment of the column and spinal canal decompression, thus minimizing the comorbidities in relation to the surgery by anterior approach and laminectomy to canal decompression