Accessing the Potential Role of Occupational Therapy in the Primary Care Setting

Background. This capstone method focuses on the limitations and barriers of type diabetic education provided in the primary care setting and calls to attention the potential role that occupational can play in the primary care setting. The prevalence of type 2 diabetes continues to rise in the United States which can be managed by providing diabetic education to patients. Primary care physicians are at the forefront to provide education or avenues to which patients obtain diabetic education to manage the disorder. Although, primary care physicians are providing diabetic education patients the current amount of education has not led to increased patient outcomes. Purpose. The purpose of this capstone project was to explore the barriers associated with the lack of type 2 diabetic education being provided to diabetic patients in the primary care setting and to gain insight into the potential role that occupational therapy can play in educating type 2 diabetics. Method. A mixed-methods approach was performed. A physician interview was conducted and a diabetic survey was provided to N=30 patients. Results. The results indicated that the primary care physician has identified several barriers associated with the lack of type 2 diabetic education being provided. The results also indicated a patient perspective with lack of type 2 diabetic education being provided to type 2 diabetic patients in the primary care setting. Discussion. This capstone project has identified the need for occupational therapy in the primary care setting

Integrity, Self-Control, and the Impact of Ego Depletion on Counterproductive Behavior

Although integrity has been found to significantly predict job performance and counterproductive behaviors, the constructs that underlie it have remained unclear. Personality, specifically conscientiousness, has been linked to integrity most consistently, but only accounts for a small amount of integrity’s variance. Research points to a relationship between integrity and self-control, but this has not been investigated. The present investigation examined the nature and implications of this relationship. Results found that self-control contributed significantly to the variance in integrity beyond conscientiousness and the other dimensions of personality. Indeed, the addition of self-control to the model, essentially eliminated conscientiousness as a significant predictor of integrity. Based on these results, it was predicted that expression of integrity would be negatively impacted by temporary detriments in self-control (i.e., ego depletion). A significant interaction was found between integrity and ego depletion in predicting off-task behavior. Examination of the interaction revealed integrity to be a significant predictor in the control, but not in the depleted, condition. However, these results are tempered by the overlap in confidence intervals between the beta weights. It is concluded that temporary detriments in self-control can negate the relationship between integrity and counterproductive behavior. Implications of these results and directions for research are also discussed

Tapped Twice: A Case of a Rapidly Re-accumulating Hepatic Hydrothorax in a Patient with Spontaneous Bacterial Empyema

Hepatic hydrothorax (HH) is a complication of decompensated liver cirrhosis that only occurs in about 5–6% of cirrhosis patients, defined as a pleural fluid in the setting of known liver disease, with the absence of any other cardiopulmonary etiology. Infected HH is a rare complication, designated as spontaneous bacterial empyema (SBEM), found in only 13–16% of patients with HH. This case follows a patient with SBEM who developed a recurrent pleural effusion minutes after thoracentesis. Our patient is a 56-year-old female with a history of alcoholic cirrhosis with pleuritic pain found to have right-sided pleural effusion with decompensation. She had no ascites. She was initiated on antibiotics due to leukocytosis and underwent thoracentesis, revealing a sterile but exudative pleural effusion with high neutrophil count, confirming the diagnosis of SBEM. Despite initial symptom relief, her respiratory symptoms recurred within mere minutes of thoracentesis. Imaging showed reaccumulated right-sided effusion, and repeat thoracentesis showed a transudative effusion, suggesting HH. While she was in our care, we pursued expert consultation with gastroenterology and thoracic surgery; based on our shared clinical decision making, we agreed that definitive intervention with either indwelling catheter or intrapleural surgical options would cause more harm than good to our patient given her decompensated alcoholic cirrhosis. The patient was discharged with instructions for serial thoracentesis and close follow-up with gastroenterology to discuss next steps regarding her advanced and uncontrolled cirrhosis. We refer to this case to discuss HH and its rare complication of SBEM, as well as the management options for patients with these conditions

Official American thoracic society clinical practice guidelines: Diagnostic evaluation of infants with recurrent or persistent wheezing

Background: Infantile wheezing is a common problem, but there are no guidelines for the evaluation of infants with recurrent or persistent wheezing that is not relieved or prevented by standard therapies. Methods: An American Thoracic Society-sanctioned guideline development committee selected clinical questions related to uncertainties or controversies in the diagnostic evaluation of wheezing infants. Members of the committee conducted pragmatic evidence syntheses, which followed the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. The evidence syntheses were used to inform the formulation and grading of recommendations. Results: The pragmatic evidence syntheses identified few studies that addressed the clinical questions. The studies that were identified constituted very low-quality evidence, consisting almost exclusively of case series with risk of selection bias, indirect patient populations, and imprecise estimates. The committee made conditional recommendations to perform bronchoscopic airway survey, bronchoalveolarlavage,esophagealpHmonitoring,andaswallowing study.Italsomadeconditionalrecommendationsagainstempiricfood avoidance, upper gastrointestinal radiography, and gastrointestinal scintigraphy. Finally, the committee recommended additional research about the roles ofinfantpulmonaryfunction testingand food avoidance or dietary changes, based on allergy testing. Conclusions: Although infantile wheezing is common, there is a paucity of evidence to guide clinicians in selecting diagnostic tests for recurrent or persistent wheezing. Our committee made several conditional recommendations to guide clinicians; however, additional research that measures clinical outcomes is needed to improve our confidence in the effects of various diagnostic interventions and to allow advice to be provided with greater confidence

Upper Elementary Boys’ Participation During Group Singing Activities in Single-sex and Coeducational Classes

As boys in the upper elementary grades become increasingly influenced by peer pressure, many are less likely to participate in singing activities because singing is considered a feminine activity. The purpose of this research was to explore if there was an effect on upper elementary boys\u27 level of participation during group singing activities when they attended music classes in a single-sex setting. This study employed a true experimental design and a mixed method. Boys (N = 186) were videotaped during their regular coeducational music classes on two occasions to establish baseline data. Then the students were randomly assigned to attend music classes in either a single-sex or coeducational group. Boys were videotaped again after seven music classes (approximately 9 weeks later). The videos were scored using the author-designed Singing Participation Measure, and the scores (N = 123) were analyzed using an analysis of variance (ANOVA). In addition, qualitative data were collected in the form of music teacher interviews and journal entries. The ANOVA showed no statistically significant differences between groups (single-sex or coeducational) or within groups (baseline scores versus post-treatment scores). In contrast, the qualitative data showed substantial differences in most of the boys\u27 participation in single-sex classes. The teachers reported a sudden increase in the boys\u27 singing participation and described numerous advantages of single-sex music education. Further research is needed. Implications for music educators suggest teachers could create single-sex singing opportunities, choose repertoire mindfully, and establish a singing culture at the school to increase boys\u27 participation during singing activities. In addition, music educators are encouraged to know their students\u27 strengths, weaknesses, interests, and needs, and to remember that one size does not fit all when it comes to what is best for developing young musicians