Listening as medicine: A thematic analysis

Realizations of the importance of “the art of medicine” in trust-building and patient satisfaction have resulted in the incorporation of narrative medicine programs into training curricula. By learning how to respond to patient stories as well as communicate their own, healthcare providers can ensure that their patients feel heard and respected. This study seeks to define what constitutes empathetic listening through a qualitative analysis of personal narratives collected from patients, caregivers, and providers across an urban academic healthcare system. Stories (n=41) underwent thematic analysis to note common experiences related to listening during a health system encounter. Eighteen grounded codes were identified which were abstracted to the following five themes: (1) connection and trust, (2) emotion and vulnerability, (3) objectives and experiences, (4) interaction and opportunity, and (5) challenges of listening. The most common theme of “connection and trust” indicated that active listening and person-centered care were key drivers of patient satisfaction and medical adherence. Encouraging patients and providers to become more comfortable verbalizing vulnerability also provided emotional relief. Taking the time to listen to patient needs and values advanced shared-decision making and facilitated the establishment of care objectives. Storytellers also conveyed the challenges inherent to the listening process. By helping to define empathetic listening, these results may enable the development of healthcare training programs centered on improving clinician communication and patient experience. We hope this study encourages future research devoted to quantifying subjective features such as “connection and trust” and “emotion and vulnerability” utilizing psychometrically validated instruments. Experience Framework This article is associated with the Patient, Family & Community Engagement lens of The Beryl Institute Experience Framework (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this lens

Conscientiousness in the Classroom: A Process Explanation

Although the research literature has established that Conscientiousness predicts task performance across a variety of achievement contexts (e.g., Barrick & Mount, 1991; OﾒConnor & Paunonen, 2007), comparatively less is known about the processes that underlie these relations. To the latter end, the current research examines effortful strategies and achievement goals as mediating factors that might explain why people with higher levels of Conscientiousness are predicted to reach higher levels of academic performance. In a longitudinal study, 347 college students completed measures of personality and achievement goals at the beginning of the class, followed by measures of effortful strategies multiple times throughout the semester. Results support the hypothesis that effortful strategies mediate the association between Conscientiousness and academic performance. Moreover, the statistical effects of Conscientiousness were generally independent of achievement goals, but a small portion of the effect was mediated through approach, not avoidance, achievement goals. These results highlight the importance of examining mediating processes between personality and outcomes, and in the case of Conscientiousness, our results suggest that effortful strategies might serve as a useful target for performance-enhancing interventions. Intelligence and hard work are often viewed as two essential ingredients for success in achievement contexts such as school and work. Consistent with this intuition, there is a well-established literature focusing on the connections between intelligence and performance (e.g., Judge, Higgins, Thoresen, & Barrick, 1999; Schmidt & Hunter, 1998), and a more recent history of research has pointed to the importance of Conscientiousness as a predictor of job performance that is relatively independent of intelligence (e.g., Barrick & Mount, 1991; Judge et al.,1999; Judge, Klinger, Simon, & Yang, 2008; Noftle & Robins, 2007; Roberts, Kuncel, Shiner, Caspi, & Goldberg, 2007). Turning to the academic context, a recent meta-analysis found that Conscientiousness, in fact, was the only practically significant personality predictor of postsecondary performance (OﾒConnor & Paunonen, 2007). Additional research is now required to understand why Conscientiousness predicts outcomes by identifying and modeling the mediating mechanisms between Conscientiousness and academic performance outcomes. In the current study, we propose that Conscientiousness is related to the types of goals, study strategies, and work habits that in turn promote success in academic contexts. We test this proposed process-based explanation using longitudinal data collected from college students. Our perspective is informed by McAdams and Pals's (2006) integrative personality framework, which identifies three major levels of personality. The first level, dispositional traits, is probably the most dominant approach in contemporary personality psychology. This level captures ﾓbroad individual differences in behavior, thought, and feeling that account for general consistencies across situations and over timeﾔ (p. 212). The second level, characteristic adaptations, incorporates social-cognitive variables such as goals that are ﾓcontextualized in time, situations, and social rolesﾔ (p. 212). The third and most fine-grained level addresses life narratives, or the construction of life stories and the development of individual identities. Our investigation focuses on the first two levels, in that we use constructs from the achievement goal literature to help explain how Conscientiousness (a dispositional or trait construct) is linked with academic outcomes. Formulating process models that bridge these two levels provides an opportunity to develop a more integrative understanding by moving beyond the study of simple trait-to-outcome correlations in the domains of personality and educational research

AMPK Is Essential to Balance Glycolysis and Mitochondrial Metabolism to Control T-ALL Cell Stress and Survival

T cell acute lymphoblastic leukemia (T-ALL) is an aggressive malignancy associated with Notch pathway mutations. While both normal activated and leukemic T cells can utilize aerobic glycolysis to support proliferation, it is unclear to what extent these cell populations are metabolically similar and if differences reveal T-ALL vulnerabilities. Here we show that aerobic glycolysis is surprisingly less active in T-ALL cells than proliferating normal T cells and that T-ALL cells are metabolically distinct. Oncogenic Notch promoted glycolysis but also induced metabolic stress that activated 5' AMP-activated kinase (AMPK). Unlike stimulated T cells, AMPK actively restrained aerobic glycolysis in T-ALL cells through inhibition of mTORC1 while promoting oxidative metabolism and mitochondrial Complex I activity. Importantly, AMPK deficiency or inhibition of Complex I led to T-ALL cell death and reduced disease burden. Thus, AMPK simultaneously inhibits anabolic growth signaling and is essential to promote mitochondrial pathways that mitigate metabolic stress and apoptosis in T-ALL

Enforced PGC-1α expression promotes CD8 T cell fitness, memory formation and antitumor immunity.

Memory CD8 T cells can provide long-term protection against tumors, which depends on their enhanced proliferative capacity, self-renewal and unique metabolic rewiring to sustain cellular fitness. Specifically, memory CD8 T cells engage oxidative phosphorylation and fatty acid oxidation to fulfill their metabolic demands. In contrast, tumor-infiltrating lymphocytes (TILs) display severe metabolic defects, which may underlie their functional decline. Here, we show that overexpression of proliferator-activated receptor gamma coactivator 1-alpha (PGC-1α), the master regulator of mitochondrial biogenesis (MB), favors CD8 T cell central memory formation rather than resident memory generation. PGC-1α-overexpressing CD8 T cells persist and mediate more robust recall responses to bacterial infection or peptide vaccination. Importantly, CD8 T cells with enhanced PGC-1α expression provide stronger antitumor immunity in a mouse melanoma model. Moreover, TILs overexpressing PGC-1α maintain higher mitochondrial activity and improved expansion when rechallenged in a tumor-free host. Altogether, our findings indicate that enforcing mitochondrial biogenesis promotes CD8 T cell memory formation, metabolic fitness, and antitumor immunity in vivo

Transformational leadership and employee well-being : the mediating role of trust in the leader and self-efficacy

Although transformational leadership (TL) is considered a kind of positive leadership, which can elevate followers in the long term, the mechanism of how TL influences employee well-being remains a relatively untouched area. Based on survey data collected from 745 employees from the People\u27s Republic of China (Beijing, n= 297; Hong Kong, n= 448), results revealed that employees\u27 trust in the leader and self-efficacy partially mediated the influence of TL on job satisfaction, and fully mediated the influence of TL on perceived work stress and stress symptoms. Implications of these findings for research and practice are discussed

Many Hands Lighter Work? Deciphering the Relationship between Adverse Working Conditions and Organization Citizenship Behaviours in Small and Medium-sized Enterprises during a Severe Economic Crisis

What is the relationship between adverse working conditions and employees’ organizational citizenship behaviour (OCB) in small and medium-sized enterprises (SMEs) operating under a severe economic crisis? To address this question, a survey of 312 front-line workers was undertaken in 62 Greek SMEs − an instrumental setting where the current deterioration of working conditions is acute. Our contribution is twofold. First, we develop and test a scale for measuring adverse working conditions. Second, we decipher the extent to which such conditions relate to organizational and individual aspects of OCB, considering job satisfaction's mediating role. Through this research we extend the OCB literature within the context of SMEs operating under severe economic crisis and highlight the implications for managing human resources in SMEs, a sector conspicuous for its socio-economic significance and its vulnerability during economic downturns

With a little help from our friends:The impact of cross‐group friendship on acculturation preferences

Despite extensive research on intergroup contact and acculturation, our understanding of how contact affects receiving society members’ preferences for acculturation orientation of immigrants over time is still relatively rudimentary. This longitudinal study examined how perceived group similarity and outgroup trust mediate the effects of cross‐group friendship on acculturation preferences (culture maintenance and culture adoption) of the receiving society. It was predicted that cross‐group friendship would affect acculturation preferences over time, and that these relationships would be partly mediated by outgroup trust and perceived group similarity. A three‐wave full longitudinal sample (N = 467 Chilean school students) was analyzed using structural equation modeling. Results confirmed that cross‐group friendship longitudinally predicted majority members’ support for the adoption of Chilean culture (via perceived group similarity) and Peruvian culture maintenance (via outgroup trust). Conceptual and practical implications are discussed

Contribution d’une catégorisation des RPS à la prédiction du stress et du burnout (ou du mal-être au travail) des soignants

Health-care professionals are strongly affected by distress at work. Our goal is to study the usefulness of a psychosocial risk measure, compared to a measure of psychosocial and organizational work constraints, on the prediction of distress among a population of caregivers. This measure is based on the categorization of psychosocial risk factors issued from the College of experts chaired by Gollac. Seven hundred and fifty-seven health-care professionals filled out a questionnaire composed of measures of psychosocial risks, psychosocial and organizational work constraints specific to caregivers, as well as stress and burnout. Results indicate that the measure of psychosocial risk better predicted the levels of stress and burnout than the measure of psychosocial and organizational work constraints