Andrea Stöckl

Towards an understanding of resilience and its relevance to medical training

Medical Education 2012: 46: 349–356

A mixed‐method approach to sense of coherence, health behaviors, self‐efficacy and optimism: Towards the operationalization of positive health attitudes

This study discusses the results of a cross-sectional survey of healthy college students in Poland. More specifically, it describes, explores, and explains the relationships between psychological variables/models such as health behaviors (HB), sense of coherence (SOC), level of optimism (LOO), and self-efficacy (SE) among college students. These separate constructs have also been used to operationalize a positive health attitude (PHA) as a novel construct. The social survey was carried out at three higher education institutions in Poland in January 2006. The random sample of 455 undergraduate students was taken from five different faculties: Physiotherapy, Physical Education, Tourism and Recreation, English Philology and Polish Philology. Four reliable and validated research tools were used to collect the data: Juczynskys Health Behaviour Inventory (HBI); Antonovskys Sense of Coherence Questionnaire (SOC-29); Schwarzer & Jerusalems Generalized Self-Efficacy Scale (GSES); and Seligmans Scale (SS). The results indicate statistically significant differences (p < 0.001) between these four variables: for example, the healthier health behaviors the stronger the sense of coherence, level of optimism and self-efficacy. It was also demonstrated that LOO, SOC, SE, and HB correlate with one another. Finally, these variables create an explicit empirical-theoretical pattern. All the research results from REGWQ tests, Pearsons correlation coefficient and cluster analysis suggest the existence of conceptual similarities between these four variables and/or the existence of some broader scientific construct such as PHA. However, this needs to be examined further. These results could be a good indicator for future research among different faculties or age groups.

The limits of empathy: problems in medical education and practice

Empathy is commonly regarded as an essential attribute for doctors and there is a conviction that empathy must be taught to medical students. Yet it is not clear exactly what empathy is, from a philosophical or sociological point of view, or whether it can be taught. The meaning, role and relevance of empathy in medical education have tended to be unquestioningly assumed; there is a need to examine and contextualise these assumptions. This paper opens up that debate, arguing that ‘empathy’, as it is commonly understood, is neither necessary nor sufficient to guarantee good medical or ethical practice.

Qi Gong exercises and Feldenkrais method from the perspective of Gestalt concept and humanistic psychology

This study describes two similar approaches to human movement: Qi Gong exercises and the Feldenkrais method. These systems are investigated in terms of Gestalt concepts and humanistic psychology. Moshe Feldenkrais created the concept known as Awareness Through Movement. This concept assumes that by becoming more aware of ones movements, one functions at a higher level. In similar ways to those using the Feldenkrais method, individuals may become more aware of their own movements by performing Qi Gong exercises: A therapeutic modality that facilitates mind-body integration. Qi Gong exercises commonly lead to increased personal awareness accompained by enhanced quality, fluency and smoothness of movement. These two methods of movement therapies are explored in terms of their relations with Gestalt concept and humanistic psychology.

Midwifery one-to-one support in labour: More than a ratio.

OBJECTIVE To explore midwifery one-to-one support in labour in a real world context of midwife-led birth environments. DESIGN Ethnographic study. Data was collected from 30 observations inside and outside the birth environments in three different birth settings. Semi-structured interviews were completed following the births with 29 low-risk women and 30 midwives with at least one year labour support experience to gain their perspectives. Twenty-seven maternity records were also analysed. SETTING An alongside midwife-led unit, freestanding midwife-led unit and womens homes in England. FINDINGS Six components of care were identified that required balance inside midwife-led birth environments: (1) presence, (2) midwife-woman relationships, (3) coping strategies, (4) labour progress, (5) birthing partners and (6) midwifery support. Midwives used their knowledge, experience and intuitive skills to synchronise their care for the six components to work in balance. Balancing of the six components have been translated into continuums representing the labour care and requirements. CONCLUSION AND IMPLICATIONS FOR PRACTICE Midwifery one-to-one support in labour is more than a ratio when translated into clinical practice. When the balance of the six components were tuned into the needs of women, women were satisfied with their labour and birth experience, even when it did not go to plan. A one midwife to one woman ratio should be available for all women in labour.

PMDs and the Moral Specialness of Medicine: An Analysis of the ‘Keepsake Ultrasound’

PMDs raise questions about the relationship between morality and medicine, threatening the conceptual discreteness of medicine itself. Everyday items such as phones or watches are increasingly used for quasi-medical purposes. Conversely, products designed for medical use are entering marketplaces and being used in ways that serve users’ values and interests without mapping neatly onto established paradigms of medical need and authority. One example of this is the so-called keepsake ultrasound. When sought outside routine medical care, our lack of ability to monitor and regulate these scans raises ethical challenges. Devices or procedures such as keepsake ultrasounds, which can have both medical and non-medical applications and which can be used by both medical professionals and members of the public, thus raise new questions for regulatory authorities.

The MMR debate in the United Kingdom

In 1998, British surgeon and researcher Andrew Wakefield published a paper in the British journal The Lancet, suggesting that there was a link between the triple vaccine against measles, mumps and rubella (MMR) and the development of childhood autism. This publication inflamed an already existing debate on the role of childhood vaccination in the UK and contributed to a substantial decline in vaccination uptake in the UK in the early 2000s. The impact of this decline was still being felt in 2012 and 2013 when a measles epidemic broke out in the Welsh city of Swansea, in which one person died and 1,200 young adults were diagnosed with measles. This chapter situates the British MMR controversy within the broader historical context of public debates over science and government policy in the years 1998–2003. We focus on the role of political leaders as models for the general public for dealing with what is broadly understood as modern risk society. In addition to previous research on the MMR debate in the UK, which locate it in the controversies on science in society and the impact of the media on decision-making processes, we adopt a socio-historical approach that allows us to contextualise the MMR debate in its relationship to the decision making processes of public figures, and here in particular Tony Blair. Through an analysis of media reports from the time, we show how a series of scandals and controversies through the early 2000s were tackled by the British government with an explicit, and sometimes

Feasibility study of a randomised controlled trial to investigate the treatment of sarcoidosis-associated fatigue with methylphenidate (FaST-MP): a study protocol

Introduction Fatigue is a frequent and troublesome manifestation of chronic sarcoidosis. This symptom can be debilitating and difficult to treat, with poor response to the treatment. Symptomatic management with neurostimulants, such as methylphenidate, is a possible treatment option. The use of such treatment strategies is not without precedent and has been trialled in cancer-related fatigue. Their use in sarcoidosis requires further evaluation before it can be recommended for clinical practice. Methods and analysis The Fatigue and Sarcoidosis—Treatment with Methylphenidate study is a randomised, controlled, parallel-arm and feasibility trial of methylphenidate for the treatment of sarcoidosis-associated fatigue. Patients are eligible if they have a diagnosis of sarcoidosis, significant fatigue (measured using the Fatigue Assessment Scale) and have stable disease. Up to 30 participants will be randomly assigned to either methylphenidate (20 mg two times per day) or identical placebo in a 3:2 ratio for 24 weeks. The primary objective is to collect data determining the feasibility of a future study powered to determine the clinical efficacy of methylphenidate for sarcoidosis-associated fatigue. The trial is presently open and will continue until July 2018. Ethics and dissemination Ethical approval for the study was granted by the Cambridge Central Research Ethics Committee on 21 June 2016 (reference 16/EE/0087) and was approved and sponsored by the Norfolk and Norwich University Hospital (reference 190280). Clinical Trial Authorisation (EudraCT number 2016-000342-60) from the Medicines and Healthcare products Regulatory Agency (MHRA) was granted on 19 April 2016. Results will be presented at relevant conferences and submitted to appropriate journals following trial closure and analysis. Trial registration number NCT02643732; Pre-results.