Clinicians share their experience of coping with the cost of caring: A good news story

There is a wealth of literature validating the notion that social workers may be vulnerable to costs associated with the performance of caring work, in other words, ‘the cost of caring’. There is also a significant amount of literature that describes the coping strategies required to manage these effects. The participants in this study illustrate that a social worker’s well being need not be sacrificed in the interest of maintaining the principle of client-centered practice. Social workers have a responsibility to care for themselves, both in the interest of offering competent services to their clients, and in order to assure one’s personal and professional well being and quality of life. Many of the coping strategies identified in the literature emphasize the role of the individual in managing the effects of the work of a therapist. However, the protective potential of these strategies may be strengthened by the existence of a supportive and understanding team and administration. It is the quality of attention paid to mitigating the possible negative effects at the level of the individual therapist, the team and the organization that is key in the possible negative effects of the work. It is with the appropriate ‘attention’ that one may experience the role of social work as rewarding and fulfilling, in effect to have the experience of ‘a good news story’

Faculty Recital:Elizabeth McGraw, Flute Ellen Schramm, Bassoon

Centennial Lecture Hall May 19, 1969 8:15 p.m

Análise de fatores que predispõe a ocorrência de miíases em cães e gatos no brasil - uma revisão de literatura

TCC(graduação) - Universidade Federal de Santa Catarina. Centro de Ciências Biológicas. Biologia.O presente trabalho é uma análise de oito publicações sobre miíases encontradas em cães e gatos no Brasil do Portal de Periódicos da CAPES/MEC após busca utilizando as palavras e operadores booleanos "myiasis" AND "domestic" AND "Brazil". Ao todo foram analisados 62 casos de miíases, sendo 42 casos registrados em cães (1 post morten) e 20 em gatos, nas regiões Centro-Oeste e Sudeste do Brasil. As espécies de mosca encontradas foram Cochliomya hominivorax (55 casos), Dermatobia hominis (1 caso), Musca domestica (1 caso), Lucilia eximia (3 casos) e Cuterebra apicalis (1 caso). Em um caso a espécie da mosca não foi identificada. A maioria dos casos reportados ocorreram nos meses de março a maio; não houve nenhum caso reportado nos meses de outubro e dezembro, e em 21 casos a data não foi informada. O cão aparece como o hospedeiro mais frequente com 42 dos 62 casos reportados, sendo o restante (20 casos) reportados em gatos, mas a diferença não foi estatisticamente significativa (p-valor Yates = 0,6747). Os animais S.R.D. predominaram, com 15 casos reportados (6 gatos e 9 cães); 20 casos ocorreram em cães de raça definida; nenhuma raça definida de gato foi identificada. A raça com mais casos relatados foi o Pastor Alemão, com sete casos relatados, enquanto as raças com menor ocorrência foram, com 1 caso relatado cada: Chow Chow, Fox Terrier, Golden Retriever, Labrador, Pastor Belga, Shar Pei e Shih Tzu. Quinze animais não tiveram sua raça informada. Animais de pelo longo apareceram com maior quantidade de casos reportados neste levantamento (N = 21), enquanto animais de pelo curto registraram 12 casos. 29 casos não tiveram o comprimento da pelagem informado. Existe possível predileção por pelagem escura quando comparado com pelagens claras e mescladas. Animais machos foram os mais acometidos por miíases do que fêmeas (38 machos contra 23 fêmeas; 1 caso não foi informado o sexo do hospedeiro), porém a diferença observada não foi estatisticamente significativa (p-valor = 0,0687). As regiões do corpo atingidas pelas miíases foram: cabeça e pescoço (24 casos); membros anteriores (7 casos); membros posteriores (8 casos); e tronco, região urogenital e cauda (22 casos), e em 1 caso não foi informada a região atingida. Animais que viviam em casas predominaram (32 casos), seguidos pelos animais de rua (20 casos), enquanto poucos casos foram relatados em animais de apartamento (5 casos) e de ambiente rural (3 casos), com diferença significativa entre a quantidade de casos reportados em animais urbanos comparado aos animais rurais (p-valor Yates = 0,0001). Não foi possível estabelecer relação entre as miíases e os parâmetros de idade e de predisposição clínica e/ou física devido ao baixo número de publicações que informaram a idade mais próxima possível dos animais. É preciso reiterar aos médicos veterinários do Brasil a necessidade de reportar por meio de publicação e notificar o MAPA os casos de miíases, a fim de identificar as regiões mais afetadas e elaborar políticas de combate e prevenção a miíases.The present work is an analysis of 8 publications on myiasis found in dogs and cats in Brazil, taken from the CAPES/MEC Periodicals Portal after searching using the Boolean words and operators "myiasis" AND "domestic" AND "Brazil". In all, 62 cases of myiasis were analyzed, 42 of which were registered in dogs (1 post morten) and 20 in cats, in the Midwest and Southeast regions of Brazil. The fly species found were Cochliomya hominivorax (55 cases), Dermatobia hominis (1 case), Musca domestica (1 case), Lucilia eximia (3 cases) and Cuterebra apicalis (1 case). In one case the fly species was not identified. Most of the reported cases occurred in the months of March to May; there were no cases reported in the months of October and December, and in 21 cases the date was not reported. The dog appears as the most frequent host with 42 of the 62 reported cases, with the remainder (20 cases) being reported in cats, but the difference was not statistically significant (p-value Yates = 0.6747). Mixed breed animals predominated, with 15 reported cases (6 cats and 9 dogs); 20 cases occurred in purebred dogs; no defined breed of cat was identified. The breed with the most reported cases was the German Shepherd, with 7 reported cases, while the breeds with the lowest occurrence were, with 1 reported case each: Chow Chow, Fox Terrier, Golden Retriever, Labrador, Belgian Shepherd, Shar Pei and Shih Tzu. 15 animals did not have their breed informed. Long-haired animals appeared with the highest number of reported cases in this survey (N = 21), while short-haired animals recorded 12 cases. 29 cases did not have the coat length reported. There is a possible predilection for dark coats when compared to light and mixed coats. Male animals were more affected by myiasis than females (38 males versus 23 females; 1 case was not informed about the host sex), but the difference observed was not statistically significant (p-value = 0.0687). The body regions affected by myiasis were head and neck (24 cases); former members (7 cases); hind limbs (8 cases); and trunk, urogenital region and tail (22 cases), and in 1 case the affected region was not informed. Animals that lived in houses predominated (32 cases), followed by stray animals (20 cases), while few cases were reported in apartment animals (5 cases) and rural animals (3 cases), with a significant difference between the number of reported cases in urban animals compared to rural animals (p-value Yates = 0.0001). It was not possible to establish a relationship between myiasis and the parameters of age and clinical and/or physical predisposition due to the low number of publications that reported the closest possible age of the animals. It is necessary to reiterate with Brazilian veterinarians the need to report through publication and notify the cases of myiasis to MAPA, in order to identify the most affected regions and develop policies to combat and prevent myiasis

University Woodwind Quintet

Centennial Lecture Hall November 25, 1968 8:15p.m

The University Woodwind Quintet

Centennial Lecture Hall April 17, 1969 8:15p.m

Maternal Transmission of Resistance to Development of Allergic Airway Disease

Parental phenotype is known to influence the inheritance of atopic diseases, such as allergic asthma, with a maternal history being a more significant risk factor for progeny than paternal history. We hypothesized that recall Th1- or Th2-type immune responses during pregnancy would result in transfer of maternal factors that would differentially impact development of immune responsiveness in offspring. Following weaning, susceptibility and severity of allergic airway disease (a murine model of human asthma) was evaluated in progeny, disease being elicited by immunization with OVA-Al(OH)3 and challenge with aerosolized OVA. We found that progeny of mothers with Th1-biased immunity to OVA subjected to recall aerosol challenge during pregnancy had reduced levels of Ag-specific IgE and airway eosinophilia compared with progeny of mothers with Th2-biased immunity to OVA or naive mothers. Interestingly, progeny of mothers with Th1-type immunity to a heterologous albumin, BSA, were not protected from developing OVA-induced allergic airway disease. These findings demonstrated that maternal transfer of protection from development of allergic airway disease to offspring in this model of maternal Th1-type immunity was Ag specific

Acquired hemophilia as the cause of life-threatening hemorrhage in a 94-year-old man: a case report

<p>Abstract</p> <p>Introduction</p> <p>Acquired factor VIII deficiency is a rare entity that can lead to severe and life-threatening bleeding. We describe a case of severe bleeding from the tongue secondary to acquired hemophilia and discuss treatment options, including aminocaproic acid and recombinant factor VIII, which have not been widely reported in the literature for the management of such patients.</p> <p>Case presentation</p> <p>A 94-year-old Caucasian man presented to our institution with diffuse bruising and extensive bleeding from the tongue secondary to mechanical trauma. He had no prior history of bleeding and his medical history was unremarkable except for dementia and hypertension. Coagulation studies revealed a prolonged activated partial thromboplastin time and a mixing study was consistent with the presence of an inhibitor. Quantitative assays revealed a reduced level of factor VIII activity (1%) and the presence of a factor VIII inhibitor, measured at seven Bethesda units, in the serum. Oral prednisone therapy (60mg/day) was given. He also received intravenous aminocaproic acid and human concentrate of factor VIII (Humate-P) and topical anti-thrombolytic agents (100 units of topical thrombin cream). His hospital course was prolonged because of persistent bleeding and the development of profuse melena. He required eight units of packed red blood cells for transfusion. Hospitalization was also complicated by bradycardia of unclear etiology, which started after infusion of aminocaproic acid. His activated partial thromboplastin time gradually normalized. He was discharged to a rehabilitation facility three weeks later with improving symptoms, stable hematocrit and resolving bruises.</p> <p>Conclusions</p> <p>Clinicians should suspect a diagnosis of acquired hemophilia in older patients with unexplained persistent and profound bleeding from uncommon soft tissues, including the tongue. Use of factor VIII (Humate-P) and aminocaproic acid can be useful in this coagulopathy but clinicians should be aware of possible life-threatening side effects in older patients, including bradycardia.</p

Changing Preferences for Survival After Hospitalization With Advanced Heart Failure

ObjectivesThis study was designed to analyze how patient preferences for survival versus quality-of-life change after hospitalization with advanced heart failure (HF).BackgroundAlthough patient-centered care is a priority, little is known about preferences to trade length of life for quality among hospitalized patients with advanced HF, and it is not known how those preferences change after hospitalization.MethodsThe time trade-off utility, symptom scores, and 6-min walk distance were measured in 287 patients in the ESCAPE (Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheter Effectiveness) trial at hospitalization and again during 6 months after therapy to relieve congestion.ResultsWillingness to trade was bimodal. At baseline, the median trade for better quality was 3 months' survival time, with a modest relation to symptom severity. Preference for survival time was stable for most patients, but increase after discharge occurred in 98 of 145 (68%) patients initially willing to trade survival time, and was more common with symptom improvement and after therapy guided by pulmonary artery catheters (p = 0.034). Adjusting days alive after hospital discharge for patients' survival preference reduced overall days by 24%, with the largest reduction among patients dying early after discharge (p = 0.0015).ConclusionsPreferences remain in favor of survival for many patients despite advanced HF symptoms, but increase further after hospitalization. The bimodal distribution and the stability of patient preference limit utility as a trial end point, but support its relevance in design of care for an individual patient

Protocol for a multicentre randomised controlled trial of STeroid Administration Routes For Idiopathic Sudden sensorineural Hearing loss:The STARFISH trial

Idiopathic sudden sensorineural hearing loss (ISSNHL) is the rapid onset of reduced hearing due to loss of function of the inner ear or hearing nerve of unknown aetiology. Evidence supports improved hearing recovery with early steroid treatment, via oral, intravenous, intratympanic or a combination of routes. The STARFISH trial aims to identify the most clinically and cost-effective route of administration of steroids as first-line treatment for ISSNHL. STARFISH is a pragmatic, multicentre, assessor-blinded, three-arm intervention, superiority randomised controlled trial (1:1:1) with an internal pilot (ISRCTN10535105, IRAS 1004878). 525 participants with ISSNHL will be recruited from approximately 75 UK Ear, Nose and Throat units. STARFISH will recruit adults with sensorineural hearing loss averaging 30dBHL or greater across three contiguous frequencies (confirmed via pure tone audiogram), with onset over a ≤3-day period, within four weeks of randomisation. Participants will be randomised to 1) oral prednisolone 1mg/Kg/day up to 60mg/day for 7 days; 2) intratympanic dexamethasone: three intratympanic injections 3.3mg/ml or 3.8mg/ml spaced 7±2 days apart; or 3) combined oral and intratympanic steroids. The primary outcome will be absolute improvement in pure tone audiogram average at 12-weeks following randomisation (0.5, 1.0, 2.0 and 4.0kHz). Secondary outcomes at 6 and 12 weeks will include: Speech, Spatial and Qualities of hearing scale, high frequency pure tone average thresholds (4.0, 6.0 and 8.0kHz), Arthur Boothroyd speech test, Vestibular Rehabilitation Benefit Questionnaire, Tinnitus Functional Index, adverse events and optional weekly online speech and pure tone hearing tests. A health economic assessment will be performed, and presented in terms of incremental cost effectiveness ratios, and cost per quality-adjusted life-year. Primary analyses will be by intention-to-treat. Oral prednisolone will be the reference. For the primary outcome, the difference between group means and 97.5% confidence intervals at each time-point will be estimated via a repeated measures mixed-effects linear regression model