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Music Therapy as a Treatment for Female Adolescents with Childhood Abuse
Get PDFThis article describes the preference to using receptive music therapy as a modality for helping an adolescent who has PTSD from childhood abuses. Adolescence is a difficult period during the life span. The second stage of separation/individuation provides challenges to almost all adolescents. This article contains a description of the adolescent behaviors of someone who is experiencing the consequences of PTSD. Along with an explanation of why receptive music therapy is an effective therapy with this population is a case study
Transitioning from Episodic to Sustained Care in Humanitarian Service
Get PDFBackground: Humanitarian missions serve populations needing care and usually provide short term interventions. Traditionally, care provided through humanitarian agencies like VOSH International has been episodic, consisting of a short-term mission placing a team in country for several days. There have been discussions that episodic care is a short term measure which impedes the systematic development of a long term solution to providing the necessary health care. The move toward sustained care is a step in the direction of improving the public health in developing countries.
Method: A survey instrument was mailed to the 26 VOSH chapters in the United States and Canada. Results were tabulated and analyzed.
Results: Sixteen completed surveys were returned for a response rate of 62%. In a one-year period, missions were carried out in 13 countries. There is a strong tendency toward continuity of care with 81% of respondents returning to locations of previous missions and 69% targeting the same population base. There is also a trend toward providing sustained care (such as establishment of a fixed clinical facility) with half responding affirmatively. Nineteen percent of chapters have been involved in the development or enhancement of departments, schools or colleges of optometry in the developing world.
Conclusion: It is exhibited in this study that most teams return to the same areas for future missions and collaborate with other partners with different expertise to create an ongoing presence. This model provides acute care for those needing immediate attention but also enhances the local infrastructure to develop a plan for long term care of this population. This allows for the opportunity to address immediate concerns, build rapport with the community, and use that goodwill and expertise to create long term change. While episodic humanitarian missions have made a profound impact, transitioning from episodic to sustained care improves overall quality of care, expanded services and long-term impact
Working Relationships Among Supervisors and Interns in Virtual Internships
Get PDFRequiring experience to get a job is a familiar adage because employers want to know that new hires can not only work but can relate with others in a specific environment. This qualitative, multi-method, interpretive study explored the virtual internship as an option to the in-person internship that also enables employers and students to work with others anywhere in the world.
Intern supervisors and student interns experiencing virtual internships were invited to share the breadth of their experiences in an online survey. Analysis of survey data provided interview topics and a prioritized list of candidates who might provide the richest and deepest account of their experiences during ensuing interviews. Interpretative phenomenological analysis was applied to survey and interview data to deduce how participants related during internships.
The principal contribution of this study is realizing that virtual internships are a meeting of cultures, the academic and working worlds, that student interns and supervisors may have differing perceptions about the internship and each other that needs reconciling to avoid conflict and to fulfill individual interests. A close working relationship is not required for easily definable work. When it is required, participants must take efforts to understand each other’s perspective, recognize they are not their role but are individuals, and that their relationship is part of a larger working community. It is incumbent therefore that they develop a relationship that works for all concerned, regardless of whether they are in-person or communicating via technology
Implementation of a Guideline for Major Depressive Disorder in a Private Practice Clinic
Get PDFMajor depressive disorder (MDD) is a chief mental health illness that carries a profound economic burden. Many who suffer from MDD find little to no relief with traditional pharmacological interventions.The 2010 American Psychiatric Association Guidelines for Treatment of Patients with MDD recognized TMS as a second-line treatment choice. Several double-blind, randomized controlled trials illustrated the efficacy and safety of TMS as a viable treatment option for MDD. The purpose of this project was to implement standardized processes through the use of a treatment guideline to help provide comprehensive treatment options for patients suffering from moderate to severe major depressive disorder (MDD).Secondary aims involved staff training on the subjective and objective components of the patient health questionnaire (PHQ-9), along with the incorporation of collateral information in determining the severity rating of depression.The final project goal was centered on patient and staff education of transcranial magnetic stimulation (TMS) as a second-line treatment option for MDD. The Plan-Do-Study-Act cycle was used to improve clinical staff knowledge on the appropriate use of clinical observations combined with collateral inputs in the scoring of the PHQ-9 scores. The number of patients diagnosed with MDD totaled 185: only 90 (48.6%) qualified for TMS. A remarkable increase in patient interest in TMS was realized after patient education was conducted, as shown by a 32.2% increase from the pre-intervention number of 3 (3.3%).The outcomes suggest standardized treatment guidelines improved patient education on alternative treatment choices. The project illustrates the importance of using guidelines to help foster equitable care
Incorporating HIV Pre-Exposure Prophylaxis in Primary Care
Get PDFIn 2012, the Food and Drug Administration approved a combination medication named Truvada (tenofovir/emtricitabine) as a prophylactic treatment to prevent HIV transmission. Truvada is also known as pre-exposure prophylaxis (PREP). PREP is a one-pill-a-day regimen proven to be 99% effective against HIV-1 transmission from sex and intravenous drug injection when taken daily. The uptake of PREP remains low because primary care providers fail to identify patients who meet the requirements to start PREP and fail to prescribe PREP for patients at risk. The purpose of this quality improvement project was to increase the uptake of PREP in patients at risk of HIV acquisition. The overall objective was to implement the U.S. Preventive Services Task Force screening guidelines for HIV acquisition risk and implement the guidelines recommended by the CDC for PREP in primary care.The providers were asked to screen all patients aged 19 to 65 years for risk of HIV acquisition during a well visit, prescribe PREP upon patients’ consent, and monitor the patients on PREP according to the standard of care. The outcomes were evaluated by retrospective chart review to ensure that 85% of the patients aged 19 to 65 years for the risk of HIV acquisition were screened. Furthermore, the providers were asked to offer PREP to 85% of patients deemed at risk and then closely monitor those on PREP for side-effects, renal function, and sexually transmitted infections to remain compliant with the standard of care andthe evidence-based guidelines. Of a total of 32 well visits, the providers screened 29 (91%) patients. Twenty-two patients were identified to be at substantial risk, and providers offered PREP to 19 (86%) patients. Three patients agreed to take PREP, and the rest refused. The providers prescribed PREP according to the standard of care for all three (100%) patients. Results showed that using the Well Visit Forms (WVFs) and the evidence-based guidelines for PREP in the primary care setting increased the number of patients identified as at risk for HIV, increased the uptake of PREP, and assisted the providers in following the standard of care in prescribing PREP
A Study of Familial and Cultural Factors Which Contributed to Degree Attainment for Nine South Texas Latinas
Get PDFResearch Focus. The Latino population is the largest and fastest growing ethnic minority in the United States. While Latino college enrollment is increasing, and dropout rates are decreasing, Latinas continue to trail behind Whites in college education and degree attainment. Latina degree attainment is half of White students, and the trend has continued since 2000 (Barshay, 2018; Harris & Tienda, 2012; Pew Research, 2019). The first step in correcting a problem is to recognize that the problem exists (Escobedo, 1980). Underrepresentation of Latinas in education has been an issue that has been addressed, but until the last few decades, corrective measures have often failed to produce favorable outcomes. Perchance the underrepresentation that overshadows Latinas is due to factors hindering degree attainment that are not clearly understood. Latina culture is foundational and a point of reference on which participants built their lives. The culture is deeply rooted in a way of life that values family above all else and measures success by the strength of those family ties (Chavez, 1991). Understanding Latino cultural values reveals how culture affects socialization and, consequently, education. The focus of this study is on Latinas who attained their doctoral degrees. The purpose is to identify influential factors that contributed to their successful terminal degree attainment and the role that family played in supporting or hindering their educationalachievement.
Research Methods. Nine south Texas Latinas were interviewed for this phenomenological study. The essence of this study was the participants’ personal interpretation of experiences that contributed to their successful achievement of their doctoral degrees. This research study was framed using a qualitative phenomenological approach for data collection and interpretation with the intent of understanding the meaning that individuals gave their educational journey and the effect their experiences had on educational attainment (Clark, 2009; Creswell, 2009; Rallis & Rossman, 2003).
Research Results/Findings. From the data emerged five major themes and five subthemes: 1. Education and Culture: Motivation and Challenges (subthemes: Education as key to a successful future; Finding it out for yourself; Learning successful strategies); 2. Significance of Support Systems (subthemes: Mother as key figure; Other support systems); 3. Adapting to Change; 4. Emerging stronger through resilience, persistence, and empowerment; and 5. Stress Management. Study results, limitations, implications, and recommendations for future research are discussed.
Conclusions From Research. The most important findings in this study were the identification of the significance of support systems and the recognition that multiple sources were critical to degree completion. Support sources were usually family members, but the support of peers, mentors, friends, and faculty members also contributed to success. Support came in many forms. Spousal support provided an additional and unexpected support system that expanded the Latinas’ circle of support. It is important to honor that there were changes in the Latino culture that had a positive impact. Further research is needed to examine how significant others can take a more pro-active role in assisting their loved one through the doctoral program. It is important to study Latinas who failed to complete their doctoral program to identify factors that hindered earning their doctoral degrees. For some of the participants in this study, mentorship provided guidance that enabled understanding of the requirements of the doctoral program. For some, mentorship was lacking and affected their ability efficiently to navigate higher education. The demands of the program produced varying degrees of difficulty, with some of those problems imposed by peers, and negative behavior was not always discouraged by mentors. Research is needed to explore how efficacious mentors facilitate the transition and successful navigation of the doctoral program. Lastly, the Latinas in this study were all south Texas residents. Research is needed to explore if the rate of Latina/o doctoral degree attainment is higher in localities with a high Latino population as opposed to other regions (Martinez, 2005). Research on doctoral degree completion in different geographical regions in Texas and perhaps the United States would be beneficial to explore to determine if the ethnic mix in a specific locale impacts doctoral completion rate
A Quality Improvement Project to Facilitate a Human Trafficking Screening Protocol at a Maternal Resource Center
Get PDFHuman trafficking is a global, criminal industry that negatively impacts the health of victims. Most U.S. victims of human trafficking are young females. Many female sex trafficking victims will seek health care services for unplanned pregnancies and sexually transmitted infections. Healthcare professionals fail to identify human trafficking victims due to lack of standardized screening. The aim of the project was to initiate a sustainable, standardized human trafficking screening protocol at a Maternal Resource Center in order to improve human trafficking identification.
This 10-week quality improvement project provided the staff and volunteers at a Maternal Resource Center with the necessary tools to implement evidence-based practices for human trafficking screening. Prior to this project there was no active, standardized screening to identify victims at the Maternal Resource Center. Objectives included addition of a human trafficking screening tool into routine clinic processes, formulation and distribution of a human trafficking resource packet for staff and qualifying clients, creation and display of a confidential human trafficking tear-off flyer, education for staff and volunteers, and the delineation of human trafficking protocol steps to facilitate safe decision-making. Of the 304 clients screened, 14 (4.6%) clients gave positive answers to human trafficking screening questions. The 14 clients included five (35.7%) victims who confirmed being trafficked, six (42.9%) clients displaying risk factors but denied being trafficked, and three (21.4%) clients with prior/current abusive relationships
Metachronous Eyelid Basal Cell Carcinoma on Opposite Eye and Lid: A Case Report
Get PDFBackground: Basal cell carcinoma (BCC) is the most common eyelid malignancy, accounting for approximately 90% of malignant eyelid lesions.1 Despite its high occurrence rates, it is frequently misdiagnosed as one of the benign “lumps and bumps” that can be present on the eyelid. In the present case, a patient with a past BCC on the right upper eyelid presented with a left lower eyelid lesion which persisted for months before the patient sought evaluation by an eyecare provider. This benign-looking lash-line lesion was the only external sign of the malignancy found on the deep surface of the eyelid and later diagnosed as BCC.
Case Report: A 74-year-old patient presented with a persistent eyelid lesion that was resistant to treatment for greater than 6 months. The small lesion was slightly suspicious in appearance. Further evaluation revealed a larger, more irregular lesion on the conjunctival surface of the eyelid. The patient was referred to an oculoplastic specialist for biopsy. Pathology confirmed the diagnosis of basal cell carcinoma.
Conclusion: Once the lesion was properly diagnosed, the patient underwent Mohs micrographic surgery and eyelid reconstruction. This case will highlight the importance of prompt and thorough evaluation of suspicious eyelid lesions which are persistent and resistant to treatment in patients with a history of eyelid malignancy
Effect of Protein, Fat, and Both Protein and Fat on the Glycemic Response of a High Glycemic Index Meal
Get PDFResearch Focus: Elevated blood glucose (BG) levels from a diet high in refined carbohydrates, even in the absence of diabetes, may increase the risk for chronic diseases including cardiovascular disease, type 2 diabetes, and obesity. The purpose of this study was to determine if supplementation of a high glycemic load breakfast with protein, fat, or a combination of the two attenuates the glycemic response in non-diabetic subjects.
Research Methods: Thirteen healthy adults, age 24.7±4y, BMI 25.1±4.5 completed four trials, having fasted 8-12h for this randomized, double-blind crossover study.
Fasting BG was measured, then subjects consumed 2 slices of white bread and 250mL of apple juice (60g carbohydrate) alone (control), or with an added protein (100kcal egg white), fat (100kcal butter), or protein+fat (50kcal egg white and 50kcal butter) within 15min, then repeated BG measurement at 15, 30, 60, 90, and 120min after baseline. ANOVA indicated that there was a difference in the time that BG peaked among the groups. Tukey’s post-hoc analysis indicated that BG peaked earlier for the added protein group compared to the added fat group (P=0.007).
Research Results/Findings: The spike was not significantly different between the control and the treatments, and there were no differences in BG at the time points measured between the control and the treatments. The spike in BG (peak minus baseline) was significantly lower with added fat compared to added protein group (69.0±15.4 vs 46.9±13.0, respectively, P
Conclusions from Research: The results of this study indicate that added protein in the form of egg white, added fat in the form of butter, and added protein and fat in the form of egg white and butter in an amount that adds 100 kcal does not attenuate the spike or overall glycemic response to an HGI meal. Added protein in the form of egg white results in a greater spike in BG compared to butter which could be from glucogenic amino acids in egg white. For this study, neither added protein or fat (or the combination of the two) blunted the glycemic response. This may be because the amount of added protein and fat used in this study was not adequate to result in a response. Additional research should be conducted to determine the types and amounts of added protein that are most effective in attenuating the glycemic response to an HGI meal
A Narrative Inquiry Exploring the Experiences of Latina Entrepreneurs in South Central Texas
Get PDFResearch Focus. The U.S. Hispanic population is the second-fastest-growing group followed by Asian Americans (Krogstad & Noe-Bustamante, 2019) and is the largest minority group in the United States (Duffin, 2020). In addition, the population of Latina women in the United States is rapidly growing and is projected to double by 2050 (Martinez-Restrepo & Stengel, 2017). On a microeconomic level, 40% of women in the United States are the primary economic source of income for their families, while on a macroeconomic level, almost 50% of women are in the workforce (DeWolf, 2017). Specifically, Latina women are becoming business owners through entrepreneurial endeavors (Bosse & Taylor, 2012). Therefore, this narrative inquiry study explored the experiences of Latina entrepreneurs in south central Texas since Texas is among the top 10 states with women-owned businesses (American Express Report, 2017).
Research Methods. A narrative inquiry design was most suitable in answering the main research question: How do Latina entrepreneurs describe their experiences of their entrepreneurial careers? Further, a narrative inquiry design allowed the researcher to understand the participants’ experiences which were thoroughly engrained in varying contexts (social, familial, linguistic, and systemic) that largely shaped their narratives (Clandinin, 2013). In addition, the methodology of utilizing testimonio was implemented to gain insight into participants’ personal stories, which brought forth an awareness of the oppressive experiences (Reyes & Rodriguez, 2012) of marginalized individuals and groups (Bernal, Burciaga, & Carmona, 2012).
Research Results/Findings. To understand the participants’ experiences and their perceptions of their entrepreneurial careers, the researcher interviewed five Latina women business owners in south central Texas. The researcher collected data from pre-interview questions, interview observations, in-depth semi-structured interviews, and documents, which revealed Latinas’ perceptions of their journeys as entrepreneurs/business owners. Data analysis was exhaustive and combined reviewing the data with the selected theoretical framework based on push-pull theory related to an entrepreneur’s motives, entrepreneurial self-efficacy theory (Boyd & Vozikis, 1994), and intersectionality theory (Crenshaw, 1989). Also, the researcher applied in vivo (Maxwell, 2013) and narrative codes (Richmond, 2002) while employing the methodology of testimonio to further understand and theorize the experiences of the Latina entrepreneurs (Bernal et al., 2012).
The findings from this narrative inquiry study uncovered that the experiences of the Latina entrepreneurs were multifaceted. Analysis of the data revealed, as expressed by the participants, how instrumental their systems of support were (social capital), the importance of obtaining knowledge and skills (human capital), drawing on various entrepreneurial qualities, overcoming challenges, and capitalizing on diverse business strategies. Participants’ informal and formal networks offered them help with things such as managing domestic duties, staying encouraged, and accessing finances, resources, and information. Some of the human capital skills the participants described were learning how to run their businesses, writing business contracts, obtaining certifications, and completing essential business paperwork. The participants’ human capital capabilities often were influenced by their previous employment experiences, formal and informal methods of training, other experiences, and, at times, some participants discussed the role of education in their lives.
The challenges the participants experienced were unique to each of them, and some obstacles they discussed revolved around balancing an array of responsibilities such as work and family, personal matters, accessing information, competition with other businesses, and business growth. Financial challenges were complex and formed many aspects, especially during the start-up phase. For example, earning income was a topic discussed along with managing the financial aspects of the business (taxes, bookkeeping, service fees). Other challenges that some of the participants described dealt with confronting gender discrimination most often imposed by their male clients.
Testimonios that surfaced depicted hardships some of the participants experienced that related to difficult relationships, health issues, and balancing family and work responsibilities. The numerous challenges all the participants faced, both professionally and personally, shed light on their resiliency in succeeding with their business ventures. Some entrepreneurial qualities that helped the participants maneuver through their personal and business challenges included remaining persistent and positive, working hard, and their faith.
Conclusions from Research. This study contributes significantly to the research on women and minority entrepreneurs and offers insight towards understanding the essence of Latina entrepreneurs’ experiences. Further recommendations can help aspiring or current entrepreneurs as they balance the personal and business challenges of being a business owner. Such guidance entails formulating systems of support (Dawson, Fuller-Love, Sinnott, & O\u27Gorman, 2011), capitalizing on individual knowledge and skills (Becker, 1964), understanding the role of personality in entrepreneurial intentions and in overcoming obstacles, and developing or enhancing necessary business skills (marketing, managing finances and other operational aspects) (Nieman & Bennet, 2006). Although each Latina entrepreneurs’ narratives were distinct, their storylines connect their experiences of their entrepreneurial careers