This document summarizes a qualitative study that interviewed 14 physicians about their experiences discussing end-of-life care with patients. The study used interpretive phenomenology to identify themes in the physicians' narratives. Key themes included rupture/interruption of normal practices, connection with patients, openness/vulnerability, presence with the patient, understanding as situated within a particular context, and what really matters to patients. The study found that recognizing personhood over medicalization and being open to patients' lived experiences can help physicians provide better end-of-life care.
One Way Out of Enactment: The Patient's Differentiation from the Therapist James Tobin
James Tobin, Ph.D. argues that a common countertransference occurrence is the therapist's identification with aspects of the patient's personhood. This identification mobilizes empathy but, ultimately must be severed by the patient's de-identification and differentiation from the therapist.
A psychological perspective on the inevitability of pain and sufferingHospiscare
Revd David Nicholson A psychological perspective on the inevitability of pain and suffering, presented at the Holy Living, Holy Dying conference held in Exeter on 2 November 2009
Chapter from the book, Duped by Kottler and Carlson. Clients who taught Barry the value of believing clients and even the therapeutic impact of a big fat lie.
One Way Out of Enactment: The Patient's Differentiation from the Therapist James Tobin
James Tobin, Ph.D. argues that a common countertransference occurrence is the therapist's identification with aspects of the patient's personhood. This identification mobilizes empathy but, ultimately must be severed by the patient's de-identification and differentiation from the therapist.
A psychological perspective on the inevitability of pain and sufferingHospiscare
Revd David Nicholson A psychological perspective on the inevitability of pain and suffering, presented at the Holy Living, Holy Dying conference held in Exeter on 2 November 2009
Chapter from the book, Duped by Kottler and Carlson. Clients who taught Barry the value of believing clients and even the therapeutic impact of a big fat lie.
“The Pure Guidelines of the Monastery
Are to be Inscribed in Your Bones and Mind”
Dogen (2010, p. 42): Mental Health Nurses’ Practices
as Ritualized Behaviour
An overview of the theories and practice principles relating to loss and bereavement. Content has kindly been provided by Barbara Beard, senior lecturer at Sheffield Hallam University, specialising in supportive and palliative care.
Understanding the Process of Supported Recoverysdewattignar
Understanding the Process of Supported Recovery
Early Intervention Services (EIS) for Psychosis are informed by a recovery-orientated approach to well-being, as defined by clients. The present research used qualitative methodology to explore the experiences of individuals as they began the process of supported recovery within the care of an EIS. Twenty clients of an EIS were interviewed to elicit their narrative accounts of their life at the time of referral through to recovery with a focus on their perceived satisfaction with the EIS. Data were then subject to thematic analysis. Those themes arising marked the defining features of the process of recovery and delineated the positive and negative influences that services can impart to their clients during this process. The process of supported recovery appeared to be mitigated by a number of factors, which if considered can enhance clinician insight and build on the treatment partnership between service and client.
The sacred nature of the doctor patient relationship. by dr. mark gignacCNPS, LLC
Dr. Mark Gignac, a Naturopathic Physician and a co-founder of Seattle Integrative Cancer Center (www.seattleintegrativecancercenter.com) describes the sacred nature of the doctor-patient relationship.
NDE Study - University of Maryland. This dissertation is based on a comprehensive study which investigated the meaning and social significance of "near-death experiences" (NDEs) by situating 50 experiencers (NDErs) as the "inside" experts on these profound, subjective experiences and their real-world impact.
I used a phenomenological, "person-centered" ethnographic approach, new to Near-Death Studies, to make experiencers' lives the orienting framework for my study. Informed by "reformist" qualitative-research ethics and health-education-and-counseling values, I analyzed study-participants' life-history narratives against medical-scientific Near-Death Studies explanatory models, an NDE-Integration-Trajectory (NDE IT) patterns model, and social construction and identity-alternation theory.
My findings were, first, that study participants' descriptions of NDE impact and aftereffects, which matched previous findings, were adequately explained by neither social construction nor medical-scientific theory.
Second, participants in this and previous studies described significant NDE interpretation and integration problems, in which I recognized a previously unidentified, health-education-and-counseling-related, pattern of unmet NDE integration needs.
Third, my findings supported the previous NDE IT findings and model; and also recognized the importance of individuals' multiple cultural meaning systems in shaping their NDE integration patterns.
Fourth, 29 of 50 study participants had not sought out and did not identify Near-Death Studies as a useful NDE integration context or resource; and they described it negatively if they mentioned it at all.
Moreover, the 21 participants who had sought a connection with Near-Death Studies expressed similar dissatisfactions.
My findings speak to the need for development of a research agenda and model(s) designed to assess and address the education and counseling needs of tens of millions of NDErs, and their health care providers.
My analysis addresses the potential social-wellness value, as well as the needs, of a community of 13 million adult NDErs, in the U.S. alone.
It situates its analysis within a context of escalating social and ecological crises and an in-progress paradigm-shift away from the still-official Newtonian/Cartesian material world view of Western culture.
It recognizes the potential social value of NDErs' collective visibility as agents, among many others of a (re)emergent sacred worldview; one that is linked to the world views of diverse indigenous knowledge systems as well as of quantum physics.
The Experience of Healthcare Assistants in Providing End of Life Care in a Co...Irish Hospice Foundation
The Experience of Healthcare Assistants in Providing End of Life Care in a Continuing Care Unit (Presentation from Dublin Community Hospital Network, February 2013) (DCN2)
Chapter 12the weak and the orphaned are deprived of justic.docxcravennichole326
Chapter 12
the weak and the orphaned are deprived of justice all the foundations of the earth are shaken. Ps. 82.3–5 Leininger (1988) maintains that caring is the essence of humanity and is essential for human growth and survival. She contends that care is one of the most powerful and elusive aspects of our health and identity and must be the central focus of nursing and the helping and healing professions. Similarly, Roach (1987) claims that care is the basic constitutive phenomenon of human existence and thus ontological in that it constitutes man as man. She points out that all existentials used to describe Dasein’s self have their central locus in care. Roach states, “When we do not care, we lose our being and care is the way back to being. Care is primordial, the source of action and is not reducible to specific actions” (1987, p. 15). Although Roach (1984) claims that caring is the human mode of being, she wonders how convincing the view is that caring is the natural expression of what is authentically human when there is so much evidence of lack of caring, both within our personal experiences as well as in the society around us. Roach points out that we live in an age where violence is commonplace and where atrocities are committed against individuals and communities everywhere. To compound the effect of such violence on the broader social body, many incidents enter our living rooms through the press, radio, and television often as quickly as they occur. As a result, modes of being with another in our world involve both caring and uncaring dimensions. What, then, are the basic modes of being with another? By analyzing two of my own studies on clients’ (patients’ and students’) perceptions of caring and uncaring encounters (Halldorsdottir, 1989, 1990), as well as related literature, I have determined that there are five basic modes of being with another as follows: life-giving (biogenic), life-sustaining (bioactive), life-neutral (biopassive), life-restraining (biostatic), and life-destroying (biocidic) (see Figure 12.1 and Table 12.1). In this chapter, I describe the five basic modes of being with another through examples of caring and uncaring encounters in hospitals as experienced by former patients, my co-researchers in the former study (Halldorsdottir, 1989). The phenomenological perspective of qualitative research theory guided the methodological approach to the studies analyzed, involving the use of theoretical sampling, intensive unstructured interviews, and constant comparative analysis. TABLE 12.1 Five Basic Modes of Being With Another Life-destroying (biocidic) mode of being with another is a mode where one depersonalizes the other, destroys the joy of life, and increases the other’s vulnerability. It causes distress and despair and hurts and deforms the other. It is transference of negative energy or darkness. Life-restraining (biostatic) mode of being with another is a mode where one is insensitive or indifferent to the ...
“The Pure Guidelines of the Monastery
Are to be Inscribed in Your Bones and Mind”
Dogen (2010, p. 42): Mental Health Nurses’ Practices
as Ritualized Behaviour
An overview of the theories and practice principles relating to loss and bereavement. Content has kindly been provided by Barbara Beard, senior lecturer at Sheffield Hallam University, specialising in supportive and palliative care.
Understanding the Process of Supported Recoverysdewattignar
Understanding the Process of Supported Recovery
Early Intervention Services (EIS) for Psychosis are informed by a recovery-orientated approach to well-being, as defined by clients. The present research used qualitative methodology to explore the experiences of individuals as they began the process of supported recovery within the care of an EIS. Twenty clients of an EIS were interviewed to elicit their narrative accounts of their life at the time of referral through to recovery with a focus on their perceived satisfaction with the EIS. Data were then subject to thematic analysis. Those themes arising marked the defining features of the process of recovery and delineated the positive and negative influences that services can impart to their clients during this process. The process of supported recovery appeared to be mitigated by a number of factors, which if considered can enhance clinician insight and build on the treatment partnership between service and client.
The sacred nature of the doctor patient relationship. by dr. mark gignacCNPS, LLC
Dr. Mark Gignac, a Naturopathic Physician and a co-founder of Seattle Integrative Cancer Center (www.seattleintegrativecancercenter.com) describes the sacred nature of the doctor-patient relationship.
NDE Study - University of Maryland. This dissertation is based on a comprehensive study which investigated the meaning and social significance of "near-death experiences" (NDEs) by situating 50 experiencers (NDErs) as the "inside" experts on these profound, subjective experiences and their real-world impact.
I used a phenomenological, "person-centered" ethnographic approach, new to Near-Death Studies, to make experiencers' lives the orienting framework for my study. Informed by "reformist" qualitative-research ethics and health-education-and-counseling values, I analyzed study-participants' life-history narratives against medical-scientific Near-Death Studies explanatory models, an NDE-Integration-Trajectory (NDE IT) patterns model, and social construction and identity-alternation theory.
My findings were, first, that study participants' descriptions of NDE impact and aftereffects, which matched previous findings, were adequately explained by neither social construction nor medical-scientific theory.
Second, participants in this and previous studies described significant NDE interpretation and integration problems, in which I recognized a previously unidentified, health-education-and-counseling-related, pattern of unmet NDE integration needs.
Third, my findings supported the previous NDE IT findings and model; and also recognized the importance of individuals' multiple cultural meaning systems in shaping their NDE integration patterns.
Fourth, 29 of 50 study participants had not sought out and did not identify Near-Death Studies as a useful NDE integration context or resource; and they described it negatively if they mentioned it at all.
Moreover, the 21 participants who had sought a connection with Near-Death Studies expressed similar dissatisfactions.
My findings speak to the need for development of a research agenda and model(s) designed to assess and address the education and counseling needs of tens of millions of NDErs, and their health care providers.
My analysis addresses the potential social-wellness value, as well as the needs, of a community of 13 million adult NDErs, in the U.S. alone.
It situates its analysis within a context of escalating social and ecological crises and an in-progress paradigm-shift away from the still-official Newtonian/Cartesian material world view of Western culture.
It recognizes the potential social value of NDErs' collective visibility as agents, among many others of a (re)emergent sacred worldview; one that is linked to the world views of diverse indigenous knowledge systems as well as of quantum physics.
The Experience of Healthcare Assistants in Providing End of Life Care in a Co...Irish Hospice Foundation
The Experience of Healthcare Assistants in Providing End of Life Care in a Continuing Care Unit (Presentation from Dublin Community Hospital Network, February 2013) (DCN2)
Chapter 12the weak and the orphaned are deprived of justic.docxcravennichole326
Chapter 12
the weak and the orphaned are deprived of justice all the foundations of the earth are shaken. Ps. 82.3–5 Leininger (1988) maintains that caring is the essence of humanity and is essential for human growth and survival. She contends that care is one of the most powerful and elusive aspects of our health and identity and must be the central focus of nursing and the helping and healing professions. Similarly, Roach (1987) claims that care is the basic constitutive phenomenon of human existence and thus ontological in that it constitutes man as man. She points out that all existentials used to describe Dasein’s self have their central locus in care. Roach states, “When we do not care, we lose our being and care is the way back to being. Care is primordial, the source of action and is not reducible to specific actions” (1987, p. 15). Although Roach (1984) claims that caring is the human mode of being, she wonders how convincing the view is that caring is the natural expression of what is authentically human when there is so much evidence of lack of caring, both within our personal experiences as well as in the society around us. Roach points out that we live in an age where violence is commonplace and where atrocities are committed against individuals and communities everywhere. To compound the effect of such violence on the broader social body, many incidents enter our living rooms through the press, radio, and television often as quickly as they occur. As a result, modes of being with another in our world involve both caring and uncaring dimensions. What, then, are the basic modes of being with another? By analyzing two of my own studies on clients’ (patients’ and students’) perceptions of caring and uncaring encounters (Halldorsdottir, 1989, 1990), as well as related literature, I have determined that there are five basic modes of being with another as follows: life-giving (biogenic), life-sustaining (bioactive), life-neutral (biopassive), life-restraining (biostatic), and life-destroying (biocidic) (see Figure 12.1 and Table 12.1). In this chapter, I describe the five basic modes of being with another through examples of caring and uncaring encounters in hospitals as experienced by former patients, my co-researchers in the former study (Halldorsdottir, 1989). The phenomenological perspective of qualitative research theory guided the methodological approach to the studies analyzed, involving the use of theoretical sampling, intensive unstructured interviews, and constant comparative analysis. TABLE 12.1 Five Basic Modes of Being With Another Life-destroying (biocidic) mode of being with another is a mode where one depersonalizes the other, destroys the joy of life, and increases the other’s vulnerability. It causes distress and despair and hurts and deforms the other. It is transference of negative energy or darkness. Life-restraining (biostatic) mode of being with another is a mode where one is insensitive or indifferent to the ...
Martha Stark MD – 1994 Working with Resistance.pdfMartha Stark MD
This book is about the patient’s resistance and his refusal to grieve. Drawing upon concepts from classical psychoanalysis, object relations theory, and self psychology, I present a model of the mind that takes into consideration the relationship between unmourned losses and how such losses are internally recorded – as both absence of good (structural deficit) and presence of bad (structural conflict). These internal records of traumatic disappointments sustained early on give rise to forces that interfere with the patient’s movement toward health – forces that constitute, therefore, the resistance.
Within the patient is a tension between that which the patient should let himself do/feel and that which he does/feels instead. Patient and therapist, as part of their work, will need to be able to understand and name, in a profoundly respectful fashion, both sets of forces –both those healthy ones, which impel the patient in the direction of progress, and those unhealthy resistive ones, which impede such progress. As part of the work to be done, the patient must eventually come to appreciate his investment in his defenses, how they serve him, and the price he pays for holding on to them.
My interest is in the interface between theory and practice –the ways in which theoretical constructs can be translated into the clinical situation; to that end, I suggest specific, prototypical interventions for each step of the working-through process.
My contention is that the resistant patient is, ultimately, someone who has not yet grieved, has not yet confronted certain intolerably painful realities about his past and present objects. Instead, he protects himself from the pain of knowing the truth about his objects by clinging to misperceptions of them; holding on to his defensive need not to know enables him not to feel his grief.
To the extent that the patient is defended, to that extent will he be resistant to doing the work that needs ultimately to be done – grief work that will enable him to let go of the past, let go of his relentless pursuit of infantile gratification, and let go of his compulsive repetitions. Only as the patient grieves, doing now what he could not possibly do as a child, will he get better.
I believe that mental health has to do with the capacity to experience one’s objects as they are, uncontaminated by the need for them to be otherwise. A goal of treatment, therefore, is to transform the patient’s need for his objects to be other than who they are into the capacity to accept them as they are.
A large no of people volunteer their time to help other people each year as seen in Ram Krishna Mission.
What is it that moves a person to give up their time, money, and even safety to relieve another person's suffering?
Compassion is the key.
Human suffering is inevitable, but our ability to understand and sympathize with the plight and circumstances of other people can play a major role in whether we take action to relieve this suffering.
Compassion is also a highly valued quality.
Religions stress the importance of compassion, while people often list characteristics such as "kind" and "compassionate" as what they look for in a potential partner.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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Ghc Msw Presentation X 22409
1. Reframing possibility and finitude through physicians' stories at the end of life Running Toward Marilyn Oakes-Greenspan,PhD, MSW Group Health Cooperative Home and Community Services February 24, 2009
2.
3. To understand the phenomena of talking about death and dying in the medical practice setting. Aim Primary Interview Question “ Tell me about a time when you talked with a patient about the end of life …”
4. About the Participants 14 physicians were interviewed 5 do rotations on a palliative care service Practice disciplines included oncology, pulmonary medicine, ICU, internal medicine, transplant, hospitalists Practice years ranged from 1st year fellowship to over thirty years after completing residency
5.
6. Interpretive Phenomenology and Narrative An interpretive phenomenological study must always involve story. Story is not only how we make sense of our experience, but also how we come to understand the situation. Story reveals context and the understanding of what was possible (and what is possible) as the story unfolds.
7.
8. Rupture: Interrupts taken for granted practices and allows one to see another way of being Connection: The need to find a starting point, and to feel integral to experience Openness and Vulnerability: Trusting one’s own instincts and strength in the presence of emotional events and expressions Presence: Being available to the person one is with, trusting both oneself and the moment Themes from the Narratives
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10. Medical Sociological Views The physician-patient relationship reveals the value of knowledge and the primacy given the physician in the relationship. Structural Functionalist Paradigm (Parsons, 1951) Roles are assumed to be hierarchical and contributory to maintaining a social norm. Tacitly accepts the duality and primacy of mind over body.
11. Medical Sociological Views Political Economy (Estes, Biggs and Phillipson, 2003) Medicalization As with aging, dying can be seen to be a medicalized condition that reflects medical failure rather than an experience of living. Theorizes that aging is constructed as medicalized and deviant in a culture that values order and sameness. Political economy analyzes the power structures that disrupt and problematize roles and social expectations.
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13. Through experience we are able to know our world, and to comprehend where we are at a certain place and in the particular situation. Our understanding is always situated, contextual and shaped by what is important to us as well as available. Organization of Themes Understanding
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16. “ So on the one hand I had a positive experience by helping him get through the first part, and was hopeful that he would be one of the ones we could cure. But in the end, dying, you know, somehow made what happened at the beginning much less important.” Experience as techne
17. Experience as Involved Concern “… it wasn’t that I was oblivious to the fact that there was a person , I was just way too scared to be able to recognize it. And I really had that very particular thought of not being able to be…the living person who said goodbye to the dying person. And since then, I’ve often seen my role as that. As one of the representatives of the people who will continue on the planet for some time after, to be able to say goodbye and to thank the person, or to recognize their passing.” (emphasis by participant).
18. Experience Experience demonstrates connection, openness and a willingness to acknowledge vulnerability when working with dying patients. Experience ‘stops us short’ by allowing us to see a different way of doing things. Experience responds to the theme of vulnerability in the way that a physician allows herself access the ability to be present, listening and attentive to patient’s concerns. Recognizing experience means the physician has granted herself access to the patient’s world of meanings and concerns.
19. Situated Understanding Our understanding of things and of what is important, is prior to what we may eventually come to know as how we do things. Comprehension of the situation is integrated with ongoing understanding of the here and now. Through experience we are able to know our world.
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21. Situated Understanding “ And I worked with that family and basically it came down to that they’re, I guess their religion wouldn’t allow that to happen and it had to sort of take its own course. And that’s a big – that creates an ethical dilemma. But for me that creates a big ethical dilemma because of the high technology that we have, we can support life for quite a long time beyond the point of which they are capable of living off all of this support. And so you start to see a very futile kind of health care delivery. But you run up that against this religious principal that says no.”
22. Situated Understanding Embodied concern reflects the temporality of illness states that changes what matters and what is possible because of our situated meanings and concerns. Our embodied lived realities cause disruption to universalisms and absolute truths.
23. Situated Understanding “ [Sharing life experiences] allows people to understand that you get it, or some of what they’re going through. You resonate with the pain, the difficulty of making those decisions and it’s not just an academic, rational, cognitive conversation. It’s an emotional affective conversation as well. And ... I teach about this with students, residents, I say, Look, if you just do the rational, cognitive, conversation, you’re doing an incomplete job—in fact, you’re doing people a disservice. And people resent it and they get angry because you’re not acknowledging that this is painful and personal and difficult .”
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26. What Matters: Habitus, environment and climate of the medical scene “ But, once that [family] meeting is over, you know, I’ve got a Swan to put in, I’ve got notes to write, I’ve got work to do. And so one of the things I’ve learned as I’ve gone through in my training and as I’ve seen more and more of these patients is to compartmentalize I think is really the best term for that. And it may sound a little cold but I think it’s really necessary to be able to get your job done. You still want to feel those things but – and you do – you can’t help it if you’re a normal human being, but you have to learn – I had to learn how to allow those emotions at times and then suppress them at others.”
27. What Matters: Habitus, environment and climate of the medical scene “ ... it would be nicer if hospice just took people who were sick . Sick enough to die without a time limit” (emphasis by participant).
28. What Matters: Habitus, environment and climate of the medical scene Context and temporality “ I think, for me, it’s meaningful just to see them all the way through ... I can’t do that on all of them, but there’s a few that just really – we bond with them. I’d do that with a lot of them if I could, I just can’t. I don’t have the time, unfortunately. If I was not in the clinic all day.”
29. “ I always try to be around if somebody’s dying just because it’s the main event. You’re an attending physician, you attend. You know, if you don’t show up, you haven’t attended.” What Matters: Habitus, environment and climate of the medical scene
30. Leaving the Medical Body Behind -- and Bringing Back the World “… the closer we become connected to others in a way that facilitates mutual respect, the better able we are to cope with their eventual loss and the prospect of our own deaths,” (Coulehan, 2005, p. 341).
31. Leaving the Medical Body Behind -- and Bringing Back the World Body as person is recognized as constitutive of the world that the person inhabits. “ ... I remember when it finally dawned on me what the problem was that mom realized what [her daughter]would want, but didn’t want to go along with it because she couldn’t face it herself, she had her own issues. That was a very tough moment because I had not encountered that before, actually.”
32. Leaving the Medical Body Behind -- and Bringing Back the World “ So I think, you know, when somebody has not had a chance to live out their life fully, or somebody who does not have, somebody who has a bunch of dependents, somebody who has a disease that’s got no name and you think you ought to be able to figure out what it is -- “… All those things ratchet up the aggressiveness, uh, and ratchet up the difficulty for everybody and the uncertainty, you know. All those things, they have to be able to face the family day in, day out and say, We know it’s not this, We know it’s not that. Still don’t know what it is. “ Obviously, I’m not going to say it that way, but I mean, that’s the content of what I have to tell them. And that’s, uh, that’s very hard.”
33. Leaving the Medical Body Behind -- and Bringing Back the World Context and lifeworld “ ... it actually takes a certain amount of concentration that is more than just talking to the patient even about their symptom. I can hear about their pain symptom much more casually than I can hear about what’s important to them and what their goals are ... I feel I really have to [pay attention], particularly in situations like this where I’m going to want to ask some difficult questions and require of them some soul-searching.”
34. Leaving the Medical Body Behind -- and Bringing Back the World “ Being responsive, being with them (patients), you gain a lot. And those gains, and the change in perspective can help you face your own losses ultimately – it helps you with other patients first, because you learn to get better at this, and then I think it eventually helps you face your own losses, personal losses.”
35. Conclusion Personhood trumps the medicalized body Expressions of care are communicated by the importance of Presence Being open and vulnerable to the situation Communicating an active state of caring
36. Conclusion Context and situated meanings inform our expressions of care and what matters to us Finitude is the expression of what we feel as the closing down of our life, who we are, what we value, and what we care about
37. Patricia Benner, PhD, RN, FAAN Dissertation Committee Chair and Academic Advisor Judith Wrubel, PhD, Sharon Kaufman, PhD and Carroll Estes, PhD, Dissertation Committee The Anselm Strauss Foundation The Century Club UCSF President’s Research Fellowship in the Humanities The physicians who agreed to be interviewed for this study, and the physicians who helped me get the interviews The Department of Social and Behavioral Sciences at UCSF Acknowledgments