Complicated Grief: Counseling Considerations and Techniques

This article presents a case study about a fictional client’s experience of complicated grief. This article differentiates between complicated grief and normal (adaptive) grief. It also distinguishes between bereavement, grief, and mourning. The counseling process is described using developmental theory and narrative reconstruction to illustrate how to implement creative techniques

Using Systems Perspectives in Supervision

This article emphasizes the important contributions of systems theory in the supervision process. A case study is used to illustrate how attention to the systemic contexts of the client, the supervisee, and the supervision process itself enlarges the possibilities for helpful change. The unifying themes of many systems theories are identified (diagnosing the system, viewing problems in context, and focusing on systemic change), and techniques for keeping supervision systemically focused are suggested. The usefulness of systems perspectives for conceptualizing diverse cultural influences and for framing advocacy efforts is explored. In addition, the supervision goals of three common systems-based approaches (structural, multigenerational, and linguistic/narrative) are presented. Specific guidance for supervisors is drawn from each approach and applied to the case study

Integrative Genomic Analysis of Cholangiocarcinoma Identifies Distinct IDH -Mutant Molecular Profiles

Cholangiocarcinoma (CCA) is an aggressive malignancy of the bile ducts, with poor prognosis and limited treatment options. Here, we describe the integrated analysis of somatic mutations, RNA expression, copy number, and DNA methylation by The Cancer Genome Atlas of a set of predominantly intrahepatic CCA cases and propose a molecular classification scheme. We identified an IDH mutant-enriched subtype with distinct molecular features including low expression of chromatin modifiers, elevated expression of mitochondrial genes, and increased mitochondrial DNA copy number. Leveraging the multi-platform data, we observed that ARID1A exhibited DNA hypermethylation and decreased expression in the IDH mutant subtype. More broadly, we found that IDH mutations are associated with an expanded histological spectrum of liver tumors with molecular features that stratify with CCA. Our studies reveal insights into the molecular pathogenesis and heterogeneity of cholangiocarcinoma and provide classification information of potential therapeutic significance

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

AN ANALYSIS OF LIFE HISTORY AND PERSONALITY CORRELATES THAT DIFFERENTIATEEFFECTIVE AND INEFFECTIVE SCHOOL COUNSELOR PREDICTORS

Abstract not availabl

Ethical Code for the International Association of Marriage and Family Counselors

The Board of Directors of the International Association of Marriage and Family Counselors (IAMFC) requested the IAMFC Ethics Committee to revise the IAMFC Ethical Code (2006). The revised Ethical Code of the IAMFC focuses on current issues in marriage and family counseling. The Ethical Code of IAMFC (2011), which appears in the following article, has been approved by the Board of Directors of IAMFC and the American Counseling Association and is consistent with the current Code of Ethics of the American Counseling Association (2005)

Venographic Changes Associated with Seeded and Nonseeded Vena Cava Grafting

Thirty-four mongrel dogs had their inferior vena cava replaced by a 10 cm porcine endothelial cell seeded or nonseeded polytetrafluroethylene graft. Graft patency at four days (documented by cavograms) was then correlated with that noted at the time of sacrifice (day 32). The overall day 32 patency rate was 32 %. Grafts seeded and treated with aspirin had the highest patency rate. Collaterals were noted on all cavograms showing clotted grafts and on none of the patent grafts. Large collaterals were seen in 25% of the subjects, and moderate and minimal collateralization occurred in 75% of the cases. No correlation was noted between graft occlusion and symptomatology