Comparing Moral Reasoning across Graduate Occupational and Physical Therapy Students and Practitioners

Practicing clinicians must use moral reasoning to solve ethical problems and combat moral distress. Development of moral reasoning in occupational therapy (OT) and physical therapy (PT) students has been significantly under researched. The purpose of this study was to analyze the differences in moral reasoning between first year and second year OT and PT students and between students and OT and PT practitioners. Investigators utilized a cross-sectional study design with a convenience sample of University of Indianapolis OT and PT students and a combination of convenience and snowball sampling to recruit licensed OT and PT practitioners. One hundred and fifty-four participants completed the Defining Issues Test - 2 (DIT-2; Rest et al., 1999) survey. Comparisons of N2 scores using t-tests found no differences between groups in moral reasoning schema (one’s preferred way of approaching moral issues, divided into stratified developmental levels). However, Pearson’s Chi-Square analysis for a comparison of all students to all practitioners for moral reasoning patterns (one’s ability to discriminate between types of moral reasoning schemas when presented with a complex moral dilemma) was significant between students (transitional) and practitioners (consolidated), with the greatest difference between second-year students and practitioners. Continual expansion of ethics content, including interjecting clinical experiences into the classroom, within OT and PT graduate programs may promote moral reasoning pattern development with carryover into practice. Clinical experiences provide real-world opportunities necessary to progress students from transitional to consolidated thinking patterns. To improve ethics education, authors recommend active learning strategies and ethics mentorship throughout clinical experiences

Psychotherapy with physically disabled patients

The psychological sequelae of physical impairments present complex challenges for scientiftc investigation and clinical practice. This paper explores some ofthe psychodynamic factors that are relevant to the experience of heing physically handicapped, which may either impede or facilitate rehahilitation efforts. The importance of psychotherapy is illustrated hy the case of a female with paraplegia who struggled with an impass in physical rehabilitation following a medullary stroke. Impediments to progress created hy the unconscious countertransference of her care providers are also examined

Medical treatment of pediatric urolithiasis

In recent years the incidence of pediatric stone disease has increased several fold, mostly due to hypercalciuria and hypocitraturia. The goal of medical treatment is to protect the patient from formation of new stones and expansion of existing ones. The non-pharmacological means to address stone disease include high fluid intake and, frequently, modification of nutritional habits. The pharmacological treatment is based on the chemical composition of the stone and the biochemical abnormalities causing its formation; hence, chemical analysis of the stone, urine and blood is of paramount importance and should be done when the first stone is detected. This review discusses the current options of medical treatment of pediatric urolithiasis

Metabolic diagnosis and medical prevention of calcium nephrolithiasis and its systemic manifestations: a consensus statement

Background: Recently published guidelines on the medical management of renal stone disease did not address relevant topics in the field of idiopathic calcium nephrolithiasis, which are important also for clinical research. Design: A steering committee identified 27 questions, which were proposed to a faculty of 44 experts in nephrolithiasis and allied fields. A systematic review of the literature was conducted and 5216 potentially relevant articles were selected; from these, 407 articles were deemed to provide useful scientific information. The Faculty, divided into working groups, analysed the relevant literature. Preliminary statements developed by each group were exhaustively discussed in plenary sessions and approved. Results: Statements were developed to inform clinicians on the identification of secondary forms of calcium nephrolithiasis and systemic complications; on the definition of idiopathic calcium nephrolithiasis; on the use of urinary tests of crystallization and of surgical observations during stone treatment in the management of these patients; on the identification of patients warranting preventive measures; on the role of fluid and nutritional measures and of drugs to prevent recurrent episodes of stones; and finally, on the cooperation between the urologist and nephrologist in the renal stone patients. Conclusions: This document has addressed idiopathic calcium nephrolithiasis from the perspective of a disease that can associate with systemic disorders, emphasizing the interplay needed between urologists and nephrologists. It is complementary to the American Urological Association and European Association of Urology guidelines. Future areas for research are identified

Rapid Scaling Up of Insecticide-Treated Bed Net Coverage in Africa and Its Relationship with Development Assistance for Health: A Systematic Synthesis of Supply, Distribution, and Household Survey Data

Stephen Lim and colleagues use several sources of data to estimate the changes in distribution of insecticide-treated bed nets across Africa between 2000 and 2008, and to analyze the link between development assistance and net coverage

A Review of Drowning Prevention Interventions for Children and Young People in High, Low and Middle Income Countries.

Globally, drowning is one of the ten leading causes of child mortality. Children aged <5 years are particularly at risk, and children and young people continue to be overrepresented in drowning statistics. Accordingly, evidence informed interventions to prevent children drowning are of global importance. This review aimed to identify, assess and analyse public health interventions to reduce child drowning and investigate the use of behavioural theories and evaluation frameworks to guide child drowning prevention. Thirteen databases were searched for relevant peer reviewed articles. The systematic review was guided by the PRISMA criteria and registered with PROSPERO. Fifteen articles were included in the final review. Studies were delivered in high, middle and low income countries. Intervention designs varied, one-third of studies targeted children under five. Almost half of the studies relied on education and information to reduce drowning deaths, only three studies used a multi-strategy approach. Minimal use of behavioural theories and/or frameworks was found and just one-third of the studies described formative evaluation. This review reveals an over reliance on education and information as a strategy to prevent drowning, despite evidence for comprehensive multi-strategy approaches. Accordingly, interventions must be supported that use a range of strategies, are shaped by theory and planning and evaluation frameworks, and are robust in intervention design, delivery and evaluation methodology. This approach will provide sound evidence that can be disseminated to inform future practice and policy for drowning prevention

Prevention and treatment of renal osteodystrophy in children on chronic renal failure: European guidelines

Childhood renal osteodystrophy (ROD) is the consequence of disturbances of the calcium-regulating hormones vitamin D and parathyroid hormone (PTH) as well as of the somatotroph hormone axis associated with local modulation of bone and growth cartilage function. The resulting growth retardation and the potentially rapid onset of ROD in children are different from ROD in adults. The biochemical changes of ROD as well as its prevention and treatment affect calcium and phosphorus homeostasis and are directly associated with the development of cardiovascular disease in pediatric renal patients. The aims of the clinical and biochemical surveillance of pediatric patients with CRF or on dialysis are prevention of hyperphosphatemia, avoidance of hypercalcemia and keeping the calcium phosphorus product below 5 mmol(2)/l(2). The PTH levels should be within the normal range in chronic renal failure (CRF) and up to 2–3 times the upper limit of normal levels in dialysed children. Prevention of ROD is expected to result in improved growth and less vascular calcification

Reading between the lines:Disk emission, wind, and accretion during the Z CMa NW outburst

(Abridged) We use optical spectroscopy to investigate the disk, wind, and accretion during the 2008 ZCMa NW outburst. Over 1000 optical emission lines reveal accretion, a variable, multi-component wind, and double-peaked lines of disk origin. The variable, non-axisymmetric, accretion-powered wind has slow ($\sim$0 km s$^{-1}$), intermediate ($\sim -$100 km s$^{-1}$) and fast ($\geq -$400 km s$^{-1}$) components. The fast components are of stellar origin and disappear in quiescence, while the slow component is less variable and could be related to a disk wind. The changes in the optical depth of the lines between outburst and quiescence are consistent with increased accretion being responsible for the observed outburst. We derive an accretion rate of 10$^{-4}$ M$_\odot$/yr in outburst. The Fe I and weak Fe II lines arise from an irradiated, flared disk at $\sim$0.5-3 $\times$M$_*$/16M$_\odot$ au with asymmetric upper layers, revealing that the energy from the accretion burst is deposited at scales below 0.5 au. Some line profiles have redshifted asymmetries, but the system is unlikely sustained by magnetospheric accretion, especially in outburst. The accretion-related structures extend over several stellar radii and, like the wind, are likely non-axisymmetric. The stellar mass may be $\sim$6-8 M$_\odot$, lower than previously thought ($\sim$16 M$_\odot$). Emission line analysis is found to be a powerful tool to study the innermost regions and accretion in stars within a very large range of effective temperatures. The density ranges in the disk and accretion structures are higher than in late-type stars, but the overall behavior, including the innermost disk emission and variable wind, is very similar independently of the spectral type. Our work suggests a common outburst behavior for stars with spectral types ranging from M-type to intermediate-mass stars.Comment: Accepted by A&A, 21 pages plus online appendix. Version 2: Minor typos corrected. Version 3: Note on DIBs added, typos correcte

Therapeutic approach to FSGS in children

Therapy of primary focal segmental glomerulosclerosis (FSGS) in children incorporates conservative management and immunosuppression regimens to control proteinuria and preserve kidney function. In long-term cohort studies in adults and children with primary FSGS, renal survival has been directly associated with degree of proteinuria control. This educational article reviews the current therapeutic approach toward children with primary FSGS

History, epidemiology and regional diversities of urolithiasis

Archeological findings give profound evidence that humans have suffered from kidney and bladder stones for centuries. Bladder stones were more prevalent during older ages, but kidney stones became more prevalent during the past 100 years, at least in the more developed countries. Also, treatment options and conservative measures, as well as ‘surgical’ interventions have also been known for a long time. Our current preventive measures are definitively comparable to those of our predecessors. Stone removal, first lithotomy for bladder stones, followed by transurethral methods, was definitively painful and had severe side effects. Then, as now, the incidence of urolithiasis in a given population was dependent on the geographic area, racial distribution, socio-economic status and dietary habits. Changes in the latter factors during the past decades have affected the incidence and also the site and chemical composition of calculi, with calcium oxalate stones being now the most prevalent. Major differences in frequency of other constituents, particularly uric acid and struvite, reflect eating habits and infection risk factors specific to certain populations. Extensive epidemiological observations have emphasized the importance of nutritional factors in the pathogenesis of urolithiasis, and specific dietary advice is, nowadays, often the most appropriate for prevention and treatment of urolithiasis