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Strange Bedfellows
It is no coincidence that presidential candidates have been making it a point to add the late-night comedy circuit to the campaign trail in recent years. In 2004, when John Kerry decided it was time to do his first national television interview, he did not choose CBS's60 Minutes, ABC'sNightline,orNBC Nightly News. Kerry picked Comedy Central'sThe Daily Show. When George W. Bush was lagging in the polls, his appearance on theDavid Letterman Showgave him a measurable boost. Candidates for the 2008 presidential election began their late-night bookings almost as soon as they launched their campaigns.
How can this be? The reason is that polls have been consistently finding that a significant number of Americans-and an even larger proportion of those under the age of thirty-get at least some of their \"news\" about politics and national affairs from comedy shows. While this trend toward what some have called \"infotainment\" seems to herald the descent of our national discourse-the triumph of entertainment over substance-the reality, according to Russell L. Peterson, is more complex. He explains that this programming is more than a mere replacement for traditional news outlets; it plays its own role in shaping public perception of government and the political process.
From Johnny Carson to Jon Stewart, from Chevy Chase's spoofing of President Ford onSaturday Night Liveto Stephen Colbert's roasting of President Bush at the White House Correspondents Dinner,Strange Bedfellowsexplores what Americans have found so funny about our political institutions and the people who inhabit them, and asks what this says about the health of our democracy. Comparing the mainstream network hosts-Jay, Dave, Conan, and Johnny before them-who have always strived to be \"equal opportunity offenders\" to the newer, edgier crop of comedians on cable networks, Peterson shows how each brand of satire plays off a different level of Americans' frustrations with politics.
eBook
8 Artificial intelligence as a mediator of experience
BackgroundThe prospect of Artificial Intelligence (AI) in health care offers new opportunities, and new perils, to patients and caregivers. One aspect of AI that is not mentioned in the dialogue between AI proponents and adversaries is the impact of AI use on human experience.ObjectivesWe postulate the opportunities and effects of AI as a mediator of experience, defined as humans’ direct interactions with the world.MethodsBy considering the ways in which AI changes the interaction of caregivers and patients with environments built to provide care, we assess novel opportunities where AI can mediate exposure to situations that sap development of human faculties. We also identify situations where AI has potential to rob humans of valuable development.ResultsCurrent AI systems can potentially correct the toxic experience of route, meaningless data entry that is prevalent throughout healthcare. The downside, habituated use of AI to replace healthy struggle – in cases such as writing – can stunt the development of human skill and replace excellence with mediocrity.ConclusionsAs a mediator of human interactions with the world, AI has the potential to help, or harm, our development as individuals and the insights we gain.
Journal Article
Aligning complex processes and electronic health record templates: a quality improvement intervention on inpatient interdisciplinary rounds
Background
Interdisciplinary rounds (IDR) with documentation have become a standard of care, but the process has been incompletely described in academic general medical settings. Checklists are promoted, yet standardized formats may not reflect the variability and work flow of rounds or support the cognitive development of medical trainees. We describe IDR processes in an academic general medicine inpatient setting and present a rapid cycle quality improvement (QI) project that improved IDR documentation rates in the electronic health record.
Methods
The project team observed existing daily IDR rounds on two medical inpatient units at the Iowa City VA Medical Center, with three resident teams and maximum census of 42 patients. The major intervention was a redesigned note template, with accompanying resident educational materials. The primary outcome was note completion rates by charge nurses; IDR team member satisfaction and participation, discussion time and balancing metrics (i.e., excess bed days of care, length of stay, and 30-day readmissions) were also assessed.
Results
An electronic template and accompanying educational materials designed to parallel the heuristic problem-solving activities of the IDR team led to improvements in IDR note completion rates from 27 to 69 %. Team member satisfaction was high and participation was stable. Discussion time per patient increased modestly, but varied widely between resident teams and by patient. Balancing metrics were unchanged. Unstructured evaluation indicated that documentation times were reduced, and IDR documentation became more timely and useful.
Conclusions
IDR notes designed to support the problem-solving processes of an interdisciplinary group improved the timeliness and perceived value of IDR documentation and met regulatory standards. Aligning complex processes and educational and documentation needs during IDR may create an efficient opportunity for sustainable interdisciplinary work and learning in an academic setting.
Journal Article
A Phenomenological Study to Understand Beginning Teacher Perceptions of Principal Support Within the First Year of Teaching
School districts across the United States have been faced with the challenge of teacher shortages (Carver-Thomas & Darling-Hammond, 2017), which have been attributed to various factors such as inadequate teacher salaries, poor working conditions, retirements, and those who leave the profession early in their careers (Becker & Grob, 2021). These teaching vacancies, commonly filled with beginning teachers fresh out of their teacher preparatory classes, have limited experiences (Clark, 2012) creating a perpetual revolving door and instability in schools (R. M. Ingersoll, 2002). This phenomenological study focused on the perceptions of seven, nontenured elementary beginning teachers and the principal support offered to them within their first year of teaching. Using semistructured interviews, the participants shared their lived experiences of the most valuable support offered by their principal and those supports that were considered lacking. Based on their responses, three themes emerged: positive interpersonal relationships, development of instructional expertise, and social-emotional support. The results of this study imply that principals can cultivate positive cultures of support to encourage beginning teachers to remain in the profession.
Dissertation
Methadone-induced Torsades de pointes
Torsades de pointes is a polymorphic ventricular tachycardia that can quickly evolve into ventricular fibrillation and sudden death. This arrhythmia often occurs secondary to medication- induced cardiac repolarization dysfunction with resultant prolonged QTc interval on ECG. Numerous medications can predispose patients to this deadly tachycardia. We report a case of methadone-induced Torsades de pointes complicated by ventricular fibrillation and cardiac arrest. Through rapid taper of methadone, the patient's ECG normalized, allowing for safe discharge. This clinical vignette highlights the importance of close monitoring of patient medications. Performing periodic ECGs with prompt removal of offending agent when repolarization abnormalities are appreciated is ideal. Most importantly, as the vast array of medications continues to grow, it is imperative that clinicians are cognizant of side effects and tailor treatment accordingly.
Journal Article
A case of intracranial hemorrhage causing stress-induced cardiomyopathy
The classic finding of Takotsubo's cardiomyopathy is left ventricular systolic dysfunction with echocardiographic evidence of apical ballooning in the absence of significant coronary disease. Intracranial hemorrhage is a known cause for stress-induced cardiomyopathy with a similar echocardiographic presentation. This diagnostic finding suggests a similar pathophysiologic mechanism between neurogenic cardiac damage and the wide array of medical and psychosocial disorders that are known to cause stress-induced cardiomyopathy (Takotsubo's syndrome). The neurogenic-cardiac variant of stress-induced cardiomyopathy is associated with good cardiovascular prog- nosis; the hallmark feature of the disorder is complete echocardiographic resolution of systolic dysfunction within a short period of time. While malignant presentations are rare, the disorder can present as severe heart failure or ventricular tachyarrhythmias. We report a case of a near life-threatening episode of polymorphic ventricular tachycardia due to a subarachnoid hemorrhage (SAH)-induced stress-cardiomyopathy.
Journal Article