The Management of Dying: Tasks and Social Relationships in Patient Care.

A grounded theory approach guides the interpretation of observational, semi-structured interviews, content analysis, and taped discourse data collected from a 48 bed oncology unit with 288 study patients. Data are presented to explicate generated concepts of regressive intervention and the dying role. Data indicate that when physicians no longer perceive their goals of cure achievable, they distance themselves from patients. Physicians use certain devices to facilitate this gradual or abrupt, but purposeful, withdrawal from patients\u27 curative regimens. These devices are specified in discourse transcripts as use of the medical record, silence, and alternative interactions (family members). Physician-authority, cautious optimistic conversational strategies, and patient role investment are peripheral factors related to regressive interventionary action. Accompanying physicians\u27 efforts to disengage are expectations upon dying patients. Patients are not expected to remain dependent upon physicians, who have already, in the process of diagnosing a fatal illness, transferred them from the sick to the dying role. Having done so, doctors no longer hold a position of primary importance in patient care although they may oversee supportive and palliative treatments. This rite of passage invites and forbids independent identity at the same moment. Dying patients are expected to limit their claim on others for attention, imposing as little burden as possible, are encouraged not to verbalize certain complaints, use a minimum of medication, and rely on themselves to the extent possible. The dying person has the right to be taken care of, but the family is expected to fill these needs. The physician\u27s and nurse\u27s roles are reserved for more important restorative functions. The obligation of staff to maintain certain humane standards of treatment for patients presents problems in the face of institutional efficiency. In conclusion, data are presented that demonstrate specific features of biomedical interaction that display a responsiveness to patients\u27 attempts to construct meaningful accounts of their problems and, further, to encourage the development of non-coercive discourse. These features are argued to improve the quality of care and to make physician purposeful withdrawal a decision based on norms of reciprocity rather than on authority-subordination

Sociomedical Perspectives on Patient Care

Social change has placed new demands on the practice of medicine, altering almost every aspect of patient care relationships. Just as medicine was encouraged to embrace the biological sciences some 100 years ago, recent directives indicate the importance of the social sciences in understanding biomedical practice. Humanistic challenges call for changes in curative and technological imperatives. In this book, social scientists contribute to such challenges by using social evidence to indicate appropriate new goals for health care in a changing environment. This book was designed to stimulate and challenge all those concerned with the human interactions that constitute medical practice. To encompass a wide range of topics, the authors include researchers; practicing physicians from the specialties of family, general, geriatric, pediatric, and oncological medicine; social and behavioral scientists; and public health representatives. Cutting across disciplinary boundaries, they explore the ethical, economic, and social aspects of patient care. These essays draw on past studies of the patient-doctor relationship and generate new and important questions. They address social behavior in patient care as a way to approach theoretical issues pertinent to the social and medical sciences. The authors also use social variables to study patient care and suggest new areas of sociomedical inquiry and new approaches to medical practice, education, and research. Its cross-disciplinary approach and jargon-free writing make this book an important and accessible tool for physician, scholar, and student. Jeffrey Michael Clair is assistant professor of sociology and medicine and director of the Medical Sociology Program at the University of Alabama at Birmingham. Richard M. Allman is associate professor of medicine and director of the University Center for Aging at the University of Alabama at Birmingham. Provides many unique and revealing perspectives on the doctor-patient relationship. —Journal of the American Medical Associationhttps://uknowledge.uky.edu/upk_medicine_and_health_sciences/1011/thumbnail.jp

Satisfaction with Medical Encounters Among Caregivers of Geriatric Outpatients

Caregivers\u27 experiences and satisfaction with physicians and medical services provided to geriatric patients are reported. An outstanding predictor of satisfaction with physician communication and overall patient care was the extent to which caregivers were experiencing role strain. Other significant predictors included caregiver knowledge of clinic and social support services provided to patients. The data suggest that, irrespective of the quality of clinic services and physician communication style, some caregivers will be dissatisfied because their encounter is mediated by the stress of activities separate from the medical encounter. We assert the importance of specialized geriatric services and argue that if these services are not in place, caregiver satisfaction with the overall medical encounter will likely be much lower

Problematics of Grounded Theory: Innovations for Developing an Increasingly Rigorous Qualitative Method

Our purpose in this article is to identify and suggest resolution for two core problematics of grounded theory. First, while grounded theory provides transparency to one part of the conceptualization process, where codes emerge directly from the data, it provides no such systematic or transparent way for gaining insight into the conceptual relationships between discovered codes. Producing a grounded theory depends not only on the definition of conceptual pieces, but the delineation of a relationship between at least two of those pieces. Second, the conceptualization process of grounded theory is done in hierarchical fashion, where individual codes emerge from the data but then are used to generate insight into more general concepts and thematic statements. But various works on grounded theory have failed to provide any systematic way of using data specific levels of scale (the codes) to gain insight into more macro levels of scale (concepts and themes). We offer fractal concept analysis as a means of resolving both of these issues. By using a logic structure generator, fractal concept analysis delineates self-similar conceptual frameworks at various levels of abstraction, yielding a method for linking concepts together within and between levels of scale encountered in the grounded theory coding and categorization process. We conclude that this fractal analytic technique can bolster the aims of grounded theory as a formalized and systematic process for generating theory from empirical data

Extracellular Vesicles Released by Cardiomyocytes in a Doxorubicin-Induced Cardiac Injury Mouse Model Contain Protein Biomarkers of Early Cardiac Injury

Purpose—Cardiac injury is a major cause of death in cancer survivors, and biomarkers for it are detectable only after tissue injury has occurred. Extracellular vesicles (EV) remove toxic biomolecules from tissues and can be detected in the blood. Here, we evaluate the potential of using circulating EVs as early diagnostic markers for long-term cardiac injury. Experimental Design—Using a mouse model of doxorubicin (DOX)-induced cardiac injury, we quantified serum EVs, analyzed proteomes, measured oxidized protein levels in serum EVs released after DOX treatment, and investigated the alteration of EV content. Results—Treatment with DOX caused a significant increase in circulating EVs (DOX_EV) compared with saline-treated controls. DOX_EVs exhibited a higher level of 4-hydroxynonenal adducted proteins, a lipid peroxidation product linked to DOX-induced cardiotoxicity. Proteomic profiling of DOX_EVs revealed the distinctive presence of brain/heart, muscle, and liver isoforms of glycogen phosphorylase (GP), and their origins were verified to be heart, skeletal muscle, and liver, respectively. The presence of brain/heart GP (PYGB) in DOX_EVs correlated with a reduction of PYGB in heart, but not brain tissues. Manganese superoxide dismutase (MnSOD) overexpression, as well as pretreatment with cardioprotective agents and MnSOD mimetics, resulted in a reduction of EV-associated PYGB in mice treated with DOX. Kinetic studies indicated that EVs containing PYGB were released prior to the rise of cardiac troponin in the blood after DOX treatment, suggesting that PYGB is an early indicator of cardiac injury. Conclusion—EVs containing PYGB are an early and sensitive biomarker of cardiac injury

Expansion of Intestinal Epithelial Stem Cells during Murine Development

Murine small intestinal crypt development is initiated during the first postnatal week. Soon after formation, overall increases in the number of crypts occurs through a bifurcating process called crypt fission, which is believed to be driven by developmental increases in the number of intestinal stem cells (ISCs). Recent evidence suggests that a heterogeneous population of ISCs exists within the adult intestine. Actively cycling ISCs are labeled by Lgr5, Ascl2 and Olfm4; whereas slowly cycling or quiescent ISC are marked by Bmi1 and mTert. The goal of this study was to correlate the expression of these markers with indirect measures of ISC expansion during development, including quantification of crypt fission and side population (SP) sorting. Significant changes were observed in the percent of crypt fission and SP cells consistent with ISC expansion between postnatal day 14 and 21. Quantitative real-time polymerase chain reaction (RT-PCR) for the various ISC marker mRNAs demonstrated divergent patterns of expression. mTert surged earliest, during the first week of life as crypts are initially being formed, whereas Lgr5 and Bmi1 peaked on day 14. Olfm4 and Ascl2 had variable expression patterns. To assess the number and location of Lgr5-expressing cells during this period, histologic sections from intestines of Lgr5-EGFP mice were subjected to quantitative analysis. There was attenuated Lgr5-EGFP expression at birth and through the first week of life. Once crypts were formed, the overall number and percent of Lgr5-EGFP positive cells per crypt remain stable throughout development and into adulthood. These data were supported by Lgr5 in situ hybridization in wild-type mice. We conclude that heterogeneous populations of ISCs are expanding as measured by SP sorting and mRNA expression at distinct developmental time points

Mastcam-Z multispectral database from the Perseverance rover’s traverse in the Jezero crater floor, Mars (sols 0-380)

NASA’s Mars-2020 Perseverance rover spent its first year in Jezero crater studying the mafic lava flows of the Máaz formation and the ultramafic cumulates of the Séítah formation. Perseverance’s Mastcam-Z instrument, a pair of multispectral, stereoscopic zoom-lens cameras, provides broadband red/green/blue (RGB), narrowband visible to near-infrared color (VNIR, 440-1020 nm wavelength range). We compiled Mastcam-Z spectra from Perseverance’s exploration of the Jezero crater floor in the first 380 sols of its mission. Here, we provide a database of ~2400 representative spectra with extensive metadata, and the locations of the regions of interest (ROIs) from which the spectra were extracted. We also include “natural color” red, green, blue (RGB) images for context, “enhanced color images” derived by stretching narrowband images, and “decorrelation stretch” (DCS) images. This dataset can serve as a baseline to interpret future observations from Perseverance’s ongoing exploration of Jezero crater, Mars