Who Helps Our Helpers? Rediscovering Joy in Medicine by Addressing Secondary Trauma

Poster presented at International Conference of Physician Health in Boston Massachusetts. Supplementary handout with definitions and extensive bibliography available at bottom of page. Film is basis for poster: Portraits of Professional Caregivers-Their Passion. Their Pain (click on picture to view movie trailer) Quotes about movie from IMDB Learning objectives 1. Become more aware of what secondary trauma is and its prevalence in health care professionals 2. Recognize the importance of personal wellness and intentional self-care by physicians and other allied professionals 3. Encourage the development of medical systems in the formation of effective peer support structures Context/background The documentary filmmaker, Vic Compher, a former administrator, supervisor and social worker in the Department of Human Services in Philadelphia, realized the presence of secondary trauma in professionals who rescue, assist and/or treat injured, traumatized or physically ill patients. His film, “Portraits of Professional Caregivers – Their Passion, Their Pain,” contains narrative interviews with a broad spectrum of professional empathetic caregivers who describe the stressful effects of their work and how those stresses affect them emotionally and functionally. The purpose of these stories is to promote awareness of secondary trauma/compassion fatigue and how it can be toxic and lead to burnout, promote provider self-care and emphasize the need for an organizational structure that provides support and healing for the medical staff. Method/approach Our poster will provide a colorful chart with the statistics of physician burnout and a display of the statistics of secondary trauma in allied professions. The poster will also include definitions of secondary trauma/compassion fatigue, burnout and compassion satisfaction. There will be dramatic still shots from the film depicting professional narratives, self-care in action and group peer debriefing/support sessions. Handouts will include a bibliography of current research, definitions and symptoms of secondary trauma and burnout, illustrations of compassion satisfaction, and examples of organizational structures that provide emotional support and healing for medical staff. Findings/results Secondary trauma is prevalent among a wide variety of professional caregivers and can lead to poor performance, dissatisfaction with work and burnout. Provider self-care and institutional support of the caregiver are crucial for promoting compassion satisfaction and resiliency. Conclusions/discussion Secondary trauma is a recognized occupational hazard of professional caregivers but can be countered by self-awareness, self-care and institutional support.https://jdc.jefferson.edu/medposters/1004/thumbnail.jp

Solar powered micrometeorite sensors using indoor ambient light for the International Space Station

Sensors for detecting micrometeorite impact locations and magnitudes as well as pressure vessel leaks have been under investigation for some time by the NASA Langley Research Center and other related entities. NASA has been investigating the use of the Distribution Impact Detection System (DIDS) for use on the International Space Station (ISS). However, the DIDS currently requires thionyl chloride lithium batteries which pose explosion and toxicity hazards, and replacing batteries is tedious and utilizes scarce man-hours. Carrying replacement batteries into space is also expensive. To hardwire new sensing devices into the ISS while in orbit would be time consuming. To overcome this problem, high efficiency GaAs solar cells have been studied under low light conditions comparable to those found inside the ISS. The cells were also studied for temperature dependence. Solar concentrators were investigated for possible use with ambient lighting. The power generated by the cells was stored in a large 300 F supercapacitor. A DC to DC boost regulator was modified to produce an output voltage of 3.55 V that is required by the DIDS. The successful operation of the DIDS with ambient light power, supercapacitor energy storage, and boost regulation was demonstrated

2005 American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Standards and Guidelines Survey

An online survey about the use and format of the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Standards and Guidelines documents was conducted. The survey was sent to A.S.P.E.N. members, and an acceptable number of responses were received (470, or 9% of those surveyed). Most respondents indicated an overall satisfaction with the standards and guidelines and suggested format changes, many of which will be incorporated into future guidelines and standards. The results of this survey are presented here for general interest. Changes in the process with which A.S.P.E.N. produces standards and guidelines are discussed

Understanding Antipsychotic Drug Use in the Nursing Home Setting

Introduction: The increasing prevalence of antipsychotic medication use in residents of nursing homes (NH) in the absence of psychiatric diagnoses is concerning. To address these concerns, it is essential to explore how these medications are being prescribed and managed in the NH setting. Our objectives were to understand the decision-making process that influences prescribing and factors that trigger administration of antipsychotic medications to residents with dementia in NHs and to explore why residents remain on antipsychotic medications over an extended period of time. Methods: Interviews with prescribers, caregivers, and family members, on-site observations in study facilities, and review of NH resident medical records. Facilities were selected to obtain a diverse sample of NHs. Results: 204 NH residents with dementia in 26 facilities distributed across five selected Centers for Medicaid and Medicare Services regions were included. Problematic behaviors were the dominant reasons offered as influencing prescribing of antipsychotic medications. Providers indicated that they chose an antipsychotic, rather than another drug class, because they believed that antipsychotic medications were more likely to be effective. There was no standard approach to taper attempts. Family members identified a lack of communication as a barrier to their involvement in decision-making. Conclusions: There is widespread perception that antipsychotic medications are effective and beneficial in managing problematic behaviors in NH residents with dementia. Little attention is given to planning for antipsychotic tapering or discontinuation. There may be opportunities to involve family members more fully in decision-making around the use of antipsychotic medications

Global Leadership Initiative on Malnutrition (GLIM):Guidance on Validation of the Operational Criteria for the Diagnosis of Protein-Energy Malnutrition in Adults

Background The Global Leadership Initiative on Malnutrition (GLIM) created a consensus-based framework consisting of phenotypic and etiologic criteria to record the occurrence of malnutrition in adults. This is a minimum set of practicable indicators for use in characterizing a patient/client as malnourished, considering the global variations in screening and nutrition assessment, and to be used across different healthcare settings. As with other consensus-based frameworks for diagnosing disease states, these operational criteria require validation and reliability testing, as they are currently based solely on expert opinion. Methods Several forms of validation and reliability are reviewed in the context of GLIM, providing guidance on how to conduct retrospective and prospective studies for criterion and construct validity. Results There are some aspects of GLIM that require refinement; research using large databases can be employed to reach this goal. Machine learning is also introduced as a potential method to support identification of the best cut points and combinations of indicators for use with the different forms of malnutrition, which the GLIM criteria were created to denote. It is noted as well that validation and reliability testing need to occur in a variety of sectors and populations and with diverse persons using GLIM criteria. Conclusion The guidance presented supports the conduct and publication of quality validation and reliability studies for GLIM

ESPEN guidelines on definitions and terminology of clinical nutrition

BACKGROUND: A lack of agreement on definitions and terminology used for nutrition-related concepts and procedures limits the development of clinical nutrition practice and research. OBJECTIVE: This initiative aimed to reach a consensus for terminology for core nutritional concepts and procedures. METHODS: The European Society of Clinical Nutrition and Metabolism (ESPEN) appointed a consensus group of clinical scientists to perform a modified Delphi process that encompassed e-mail communication, face-to-face meetings, in-group ballots and an electronic ESPEN membership Delphi round. RESULTS: Five key areas related to clinical nutrition were identified: concepts; procedures; organisation; delivery; and products. One core concept of clinical nutrition is malnutrition/undernutrition, which includes disease-related malnutrition (DRM) with (eq. cachexia) and without inflammation, and malnutrition/undernutrition without disease, e.g. hunger-related malnutrition. Over-nutrition (overweight and obesity) is another core concept. Sarcopenia and frailty were agreed to be separate conditions often associated with malnutrition. Examples of nutritional procedures identified include screening for subjects at nutritional risk followed by a complete nutritional assessment. Hospital and care facility catering are the basic organizational forms for providing nutrition. Oral nutritional supplementation is the preferred way of nutrition therapy but if inadequate then other forms of medical nutrition therapy, i.e. enteral tube feeding and parenteral (intravenous) nutrition, becomes the major way of nutrient delivery. CONCLUSION: An agreement of basic nutritional terminology to be used in clinical practice, research, and the ESPEN guideline developments has been established. This terminology consensus may help to support future global consensus efforts and updates of classification systems such as the International Classification of Disease (ICD). The continuous growth of knowledge in all areas addressed in this statement will provide the foundation for future revisions

Changes in Whole Blood Gene Expression in Obese Subjects with Type 2 Diabetes Following Bariatric Surgery: a Pilot Study

A pilot study was performed in order to investigate the effects of bariatric surgery on whole blood gene expression profiles in obese subjects with type 2 diabetes.Whole blood from eleven obese subjects with type 2 diabetes was collected in PAXgene tubes prior to and 6-12 months after bariatric surgery. Total RNA was isolated, amplified, labeled and hybridized to Illumina gene expression microarrays. Clinical and expression data were analyzed using a paired t-test, and correlations between changes in clinical trait and transcript levels were calculated. Pathways were identified using Ingenuity Pathway Analysis and DAVID gene ontology software. Overall, bariatric surgery resulted in significant reduction of body mass index, fasting plasma glucose, fasting plasma insulin, and normalization of glycosylated hemoglobin levels. The expression levels of 204 transcripts, representing 200 unique genes, were significantly altered after bariatric surgery. Among the significantly regulated genes were GGT1, CAMP, DEFA1, LCN2, TP53, PDSS1, OLR1, CNTNAP5, DHCR24, HHAT and SARDH, which have been previously implicated in lipid metabolism, obesity and/or type 2 diabetes. Selected findings were replicated by quantitative real-time-PCR. The changes in expression of seven transcripts, WDR35, FLF45244, DHCR24, TIGD7, TOPBP1, TSHZ1, and FAM8A1 were strongly correlated with the changes in body weight, fasting plasma glucose and glycosylated hemoglobin content. The top pathways associated with gene expression changes after bariatric surgery was lipid metabolism, small molecule biochemistry and gene expression. Two antimicrobial peptides were among the transcripts with the largest changes in gene expression after bariatric surgery.Data from this pilot study suggest that whole blood expression levels of specific transcripts may be useful as biomarkers associated with susceptibility for type 2 diabetes and/or therapeutic response

Metabolic responses to the acute ingestion of two commercially available carbonated beverages: A pilot study

<p>Abstract</p> <p>Background</p> <p>The purpose of this placebo-controlled, double-blind cross-over study was to compare the effects of two commercially available soft drinks on metabolic rate.</p> <p>Methods</p> <p>After giving informed consent, twenty healthy men and women were randomly assigned to ingest 12 ounces of Celsius™ and, on a separate day, 12 ounces of Diet Coke®. All subjects completed both trials using a randomized, counterbalanced design. Metabolic rate (via indirect calorimetry) and substrate oxidation (via respiratory exchange ratio) were measured at baseline (pre-ingestion) and at the end of each hour for 3 hours post-ingestion.</p> <p>Results</p> <p>Two-way ANOVA revealed a significant interaction (p < 0.001) between trials in metabolic rate. Scheffe post-hoc testing indicated that metabolic rate increased by 13.8% (+ 0.6 L/min, p < 0.001) 1 hr post, 14.4% (+0.63 L/min, p < 0.001) 2 hr post, and 8.5% (+0.37 L/min, p < 0.004) 3 hr post Celsius™ ingestion. In contrast, small (~4–6%) but statistically insignificant increases in metabolic rate were noted following Diet Coke^®ingestion. No differences in respiratory exchange ratio were noted between trials.</p> <p>Conclusion</p> <p>These preliminary findings indicate Celsius™ has thermogenic properties when ingested acutely. The effects of repeated, chronic ingestion of Celsius™ on body composition are unknown at this time.</p