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This book provides an in-depth look at what a little-known clinician, the educational therapist, does and how they do it. It goes behind the clinician’s door to illustrate the unusual and broad range of interventions?both academic/vocational and social/emotional?that an educational therapist employs. This particular case study involves a young woman called Nora who had a severe but undiagnosed auditory processing disorder. She could not give meaning to the spoken language that came at her too rapidly, leaving her in a constant fog of words that she could not comprehend. This case discloses the problems, their causes, and the emotional toll that had to be considered when developing an effective educational/therapeutic plan for Nora. It vividly illustrates the dynamic exchanges and mutual learning that goes on between client and therapist. Parts One and Two illustrate how the psycho-educational interventions that addressed Nora’s academic and non-academic needs were gradually formulated over the first year. Part Three provides a series of vignettes from subsequent years that illustrate the ongoing applications of the therapist’s work. Distinguishing Features Explanatory Commentaries?—The rationale behind particular techniques and interventions is clarified through a system of explanatory commentaries that inform the reader without distracting from the story. This approach makes the book both an instructional tool and a compelling story. Organic Curriculum—The rationale for and application of an “Organic (personalized) Curriculum\" is explained and applied throughout the book as a model for others to use in working with this population. A Longitudinal Perspective?—The initial work with Nora began many years ago, so this book provides a long view of her life and tracks the influences that educational therapy exerted on her development into a fully functioning adult. Cognitive/Emotional Integration?—The core of educational therapy?the interdependence of cognitive skills and emotional response?is clearly documented throughout the book. In addition to educational therapy students and practitioners, this book is appropriate for those working in related fields such as special education, school psychology, school counselling, and social work in educational settings.

The number of children on a vegetarian or vegan diet is gradually increasing. If not balanced and adequately supplemented, these dietary regimes can seriously impact the growth of children. Often the pediatrician is not perceived as a figure to rely on in the event of parents’ willingness to follow an alternative diet for their child. The feeling of distrust of parents towards the pediatrician can be dangerous for the health of the child. We present a 22-month-old boy with failure to thrive probably induced by an unbalanced vegetarian diet. The acquisition of the anamnestic data concerning the child’s diet was difficult because initially omitted by the parents. The poor compliance and the difficult follow-up highlights the difficulty in establishing a therapeutic alliance between parents who follow alternative regimens and the pediatrician.

BackgroundDisparities in tobacco use are worsening in the United States, disproportionately affecting those with chronic medical conditions. One possible contributor is that physicians may not screen and advise cessation uniformly across patients and/or tobacco products.ObjectiveThis study examined provider communications regarding cigarette and non-cigarette tobacco products among adults with chronic conditions.DesignCross-sectional study drawn from two waves (2013–2014) of the National Survey on Drug Use and Health (NSDUH).ParticipantsAdults (≥ 18 years) who used tobacco in the past year.Main MeasuresPrevalence of tobacco use included past-year use of cigarettes, cigars, or smokeless tobacco among those with and without chronic conditions. Chronic conditions included asthma, anxiety, coronary heart disease, depression, diabetes, hepatitis, HIV, hypertension, lung cancer, stroke, and substance abuse. Odds ratio of receipt of screening and advice to quit across chronic condition and tobacco product type were reported. Data were analyzed using logistic regression, controlling for basic sociodemographic factors and number of provider visits.Key ResultsAdults with anxiety, depression, and substance use disorders had the highest prevalence of past-year cigarette (37.2–58.2%), cigar (9.1–28.0%), and smokeless tobacco (3.1–11.7%) use. Patients with any chronic condition were more likely to receive advice to quit than those without a condition (OR 1.21–2.37, p < 0.01), although the odds were lowest among adults with mental health and substance use disorders (OR 1.21–1.35, p < 0.01). Cigarette smokers were more likely to report being screened and advised to quit than non-cigarette tobacco users (OR 1.54–5.71, p < 0.01).ConclusionsResults support the need for provider training to expand screening and cessation interventions to include the growing spectrum of tobacco products. Screening and referral to interventions are especially needed for those with mental health and substance use disorders to reduce the disparate burden of tobacco-related disease and death.

Patients with diabetes and poorly controlled hypertension are at increased risk for adverse renal and cardiovascular outcomes. Identifying these patients early and addressing modifiable risk factors is central to delaying renal complications such as diabetic kidney disease. Mobile health (mHealth), a relatively inexpensive and easily scalable technology, can facilitate patient-centered care and promote engagement in self-management, particularly for patients of lower socioeconomic status. Thus, mHealth may be a cost-effective way to deliver self-management education and support. This feasibility study aimed to build a population management program by identifying patients with diabetes and poorly controlled hypertension who were at risk for adverse renal outcomes and evaluate a multifactorial intervention to address medication self-management. We recruited patients from a federally qualified health center (FQHC) in an underserved, diverse county in the southeastern United States. Patients were identified via electronic health record. Inclusion criteria were age between 18 and 75 years, diagnosis of type 2 diabetes, poorly controlled hypertension over the last 12 months (mean clinic systolic blood pressure [SBP] ≥140 mm Hg and/or diastolic blood pressure [DBP] ≥90 mm Hg), access to a mobile phone, and ability to receive text messages and emails. The intervention consisted of monthly telephone calls for 6 months by a case manager and weekly, one-way informational text messages. Engagement was defined as the number of phone calls completed during the intervention; individuals who completed 4 or more calls were considered engaged. The primary outcome was change in SBP at the conclusion of the intervention. Of the 141 patients enrolled, 84.0% (118/141) of patients completed 1 or more phone calls and had follow-up SBP measurements for analysis. These patients were on average 56.9 years of age, predominately female (73/118, 61.9%), and nonwhite by self-report (103/118, 87.3%). The proportion of participants with poor baseline SBP control (50/118, 42.4%) did not change significantly at study completion (53/118, 44.9%) (P=.64). Participants who completed 4 or more phone calls (98/118, 83.1%) did not experience a statistically significant decrease in SBP when compared to those who completed fewer calls. We did not reduce uncontrolled hypertension even among the more highly engaged. However, 83% of a predominately minority and low-income population completed at least 67% of the multimodal mHealth intervention. Findings suggest that combining an automated electronic health record system to identify at-risk patients with a tailored mHealth protocol can provide education to this population. While this intervention was insufficient to effect behavioral change resulting in better hypertension control, it does suggest that this FQHC population will engage in low-cost population health applications with a potentially promising impact. ClinicalTrials.gov NCT02418091; https://clinicaltrials.gov/ct2/show/NCT02418091 (Archived by WebCite at http://www.webcitation.org/76RBvacVU).

This paper presents an in-depth case study of the dynamic processes of mutual adjustment that occurred between two professional teams participating in a multicomponent community-based intervention (CBI). Drawing on the concept of social regularities, we focus on patterns of social interaction within and across the two microsystems involved in delivering the intervention. Two research strategies, narrative analysis and structural network analysis, were used to reveal the social regularities linking the two microsystems. Results document strategies and actions undertaken by the professionals responsible for the intervention to modify intersetting social regularities to deal with a problem situation that arose during the course of one intervention cycle. The results illustrate how key social regularities were modified in order to resolve the problem situation and allow the intervention to continue to function smoothly. We propose that these changes represent a transition to a new state of the ecological intervention system. This transformation appeared to be the result of certain key intervening mechanisms: changing key role relationships, boundary spanning, and synergy. The transformation also appeared to be linked to positive setting-level and individual-level outcomes: confidence of key team members, joint planning, decision-making and intervention activities, and the achievement of desired intervention objectives.

Background Continuity of care can bring a wide range of benefits to consumers, providers and health care systems. This study aimed to understand the relationship preferences of primary care patients and their associations with patient experience of continuity of care. Methods A questionnaire survey was conducted on 700 patients who sought medical care from a community health organisation in Beijing. The survey contained four items examining the relationship preferences of the respondents, and a modified Questionnaire of Continuity between Care Levels (CCAENA) measuring patient experience of continuity of care based on a three dimensional (relational, informational and managerial) model. The associations between the relationship preferences and the experience of respondents in continuity of care was tested using a linear regression model controlling for age, sex, education, medical insurance, personal income and servicing facilities. Results The respondents experienced relatively lower levels of informational and managerial continuity compared with relational continuity of care. More than 80% of respondents preferred free choice and a continuing relationship with doctors, compared with 59% who endorsed community facility control over hospital appointments. A preference for a continuing relationship with doctors was associated with all aspects of continuity of care. A preference in favour of community facility control over hospital appointments was a strong predictor of managerial continuity ( β  = 0.333, p  < 0.001) and informational continuity ( β  = 0.256, p  < 0.001). Patient preference for free choice of doctors was positively associated with relational continuity with specialists ( p  < 0.001), but not with primary care providers ( p  > 0.08). Perceived importance of information exchange was associated with relational and managerial continuity ( p  < 0.05), but not with informational continuity ( p  = 0.34). Conclusions Patients prefer a high level of freedom of choice and sustained individual relationship with doctors. Relationship preferences of patients are associated with their experience of continuity of care. But patient strong preference for free choice of doctors is not aligned with relational continuity with primary care, a desirable feature of cost-effective healthcare systems.

Repeated exposure to violence is a risk factor for burnout [3]. [...]agitation is a clinical presentation with a broad differential diagnosis including myriad life-threatening medical conditions [4]. The presence of agitation may also complicate the diagnosis and treatment of concurrent conditions. [...]trainees must learn to manage agitated patients in order to feel safe at work, maintain the safety of their patients and colleagues, and appropriately treat severe medical and psychiatric illnesses. In this paper, we describe our production and evaluation of a video curriculum designed to teach medical students core principles in the management of agitation through verbal de-escalation. Description of a video curriculum to teach verbal de-escalation Chapter (running time, mm:ss) Chapter objectives Web address Identification and assessment of agitation (8:27) 1.