A grounded theory methodology was used to explore patients' experiences with end-stage renal disease (ESRD) and hemodialysis. The emerging theory suggests that a "new sense of self" is an emotional/psychological state that fluctuates with the evolving meanings of illness and treatment and perceived quality of supports. The findings indicate that when confronted with this new way of being in the world, the individual becomes cognizant of an uncertain future, continued dependence on life-sustaining technology and the expertise of health care providers, and the demands on and sacrifices incurred by significant others. All aspects of patients' experiences with ESRD and hemodialysis treatment must be considered if health care providers are to facilitate positive health outcomes.
Research on children with autism and pervasive developmental disorders (PDD) has identified deficits and differences in social-communicative and related symbolic abilities. This includes a limited range of communicative functions, limited ability to use conventional preverbal and verbal means of communicating, lack of pretend play, and limited use of shared positive affect and eye gaze to regulate communicative interactions. However, most previous research has studied older preschool and school-age children and has measured one aspect of social skills. This study examined developmental profiles of two groups of young children with atypical language development using the Communication and Symbolic Behavior Scales (CSBS; Wetherby & Prizant, 1993). One group had been diagnosed with PDD (APA, 1994) and the second group had developmental language delays where the diagnosis of PDD had been ruled out. The results indicated that CSBS profiles of the group with PDD reflected a distinct pattern of relative strengths and weaknesses that was substantially different from the other group on 15 of the 22 CSBS scales. Significant differences were found in the clusters of communicative functions, gestural communicative means, reciprocity, social/affective signaling, and symbolic behavior. The younger children in the PDD group showed results similar to the older children, with more pronounced deficits in vocal and verbal means. Correlational findings indicate three clusters of impairments involving joint attention, symbolic play, and social/affective signaling. The implications of these findings are discussed in regard to earlier identification and intervention planning.
Person-centered medicine, while valued implicitly, is not always taught explicitly in medical schools or during residency programs. Threats to educating and practicing person-centered medicine include perceived lack of time, stress, burnout and a paucity of mentors with a systematic approach to modeling and teaching students how to relate to patients in a way that addresses them as whole persons. Herein we review how trainee stress and burnout negatively impact patient care and outline a program designed to teach mindful medical practice that may be an antidote to these problems. Moreover, we present quantitative data and a student’s narrative to highlight how to cultivate person-centered medicine in trainees.Fifty-eight 4th year medical students completed questionnaires pertaining to: depression, burnout, stress, wellbeing, self-compassion and mindfulness before and after taking a 4-week elective entitled, Mindful Medical Practice. Statistically significant improvements were found on emotional exhaustion, depression, self-compassion and mindfulness. One student’s experiences highlighted how what he learned in the elective guided him during his family medicine residency. We conclude with a discussion of how the culture of medicine and the training of future physicians in particular, need to take the whole persons of both the physician and patient into account in order for all to be satisfied with and benefit from medical care.
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