Re: Episode 1.15 Full Movie Free Download
Ludmila Hargett
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Background: Being able to estimate the likelihood of poor recovery from episodes of back pain is important for care. Studies of psychosocial factors in inception cohorts in general practice and occupational populations have begun to make inroads to these problems. However, no studies have yet investigated this in chiropractic patients.
Methods: A prospective inception cohort study of patients presenting to a UK chiropractic practice for new episodes of non-specific low back pain (LBP) was conducted. Baseline questionnaires asked about age, gender, occupation, work status, duration of current episode, chronicity, aggravating features and bothersomeness using Deyo's 'Core Set'. Psychological factors (fear-avoidance beliefs, inevitability, anxiety/distress and coping, and co-morbidity were also assessed at baseline. Satisfaction with care, number of attendances and pain impact were determined at 6 weeks. Predictors of poor outcome were sought by the calculation of relative risk ratios.
Conclusion: Patients attending a private UK chiropractic clinic for new episodes of non-specific LBP exhibited few psychosocial predictors of poor outcome, unlike other patient populations that have been studied. Despite considerable bothersomeness at baseline, scores were low at follow-up. In this independent health sector back pain population, general health and duration of episode before consulting appeared more important to outcome than psychosocial factors.
Background: Status epilepticus (SE) is a neurological emergency characterized by prolonged seizures. However, the incidence of first-episode SE is unclear, as estimates vary greatly among studies. Additionally, SE risk factors have been insufficiently explored. Therefore, the objectives of this study were to estimate the incidence of first-episode SE in Ontario, Canada, and estimate the associations between potential sociodemographic and health-related risk factors and first-episode SE.
Methods: We conducted a population-based retrospective cohort study using linked health administrative datasets. We included individuals who completed Canada's 2006 Census long-form questionnaire, lived in Ontario, were between 18 and 105, and had no history of SE. A Cox proportional hazards regression model was used to estimate the hazard ratios for SE within three years associated with each potential risk factor.
Conclusion: The estimated incidence of SE in a sample of Ontario residents was 3.5 per 100,000 person-years. Older age and several comorbid conditions were associated with higher first-episode SE risk.
Today we're going to be talking about something that's not necessarily uplifting, but it's incredibly important. We're going to be talking about why social workers, especially those of us in private practice, really need to have a professional will. In the Social Work NASW Code of Ethics, Section 1.15 explains that social workers have an ethical obligation to plan for unexpected interruption of services due to illness or death. So this is an ethics issue, and it's one that is incredibly overlooked in the literature, in the academy, and in spheres of continuing social work education. Now with more than a million lives lost to COVID, it highlights all the more that it is necessary for us to face that unexpected illness and death happens, and we must have a professional will in place for our clients. But if you're listening right now and you don't have one, you are not alone.
And that's why I am so pleased to welcome today to Social Work Talks, dr. Ann Steiner. Dr. Steiner is a pioneer in this area. She has published over 20 articles on the topic of professional wills. For 14 years she taught at UC San Francisco and she is on the diversity, equity and inclusion task force of the American Group Psychotherapy Association. In addition to all of this, Dr. Steiner is in the process of publishing an ebook that you can download to create your own professional will, so we'll talk more about that later. Dr. Ann Steiner, welcome to Social Work Talks. Thank you for joining us.
Dr. Ann Steiner:
Okay. Well, first I want to echo what you started with, which is that many people don't realize that this is an ethics requirement and it's actually an ethics requirement for every single mental health discipline, so that when you renew your membership, at the bottom it will say, "I agree to abide by the ethics." And most of us just sign that, assuming we know what the ethics are. And in fact, there is this section that NASW has had for years that says that there's an ethical mandate in essence to have the equivalent of a backup system so that you provide for continuity of care in the event of your expected and unexpected absence. So that's the overview. Then in terms of the nuts and bolts, the bottom line is to really understand what the reasons are for having a professional room.
This is essentially a system to protect you, your practice in your community. It's a system I've worked, on creating it so that it's a little easier for people to put together, but in essence it's having a team of people that you pick by hand that you trust to take over your practice if you get COVID, if you get the flu and lose your voice. Right now, if something happened to either of us, who do we have that we could send one text to, to say, "Please contact my patients and cancel them for the next week, because I don't feel well enough to be able to do that."
Elisabeth LaMotte:
Well, thanks to you, who I have is a bridge therapist, because I took your ethics workshop at the AGPA conference, not once, but twice, to make sure that I had this in place. So thank you. I happened to have the plan, but I didn't always have the plan. For many years I didn't.
Dr. Ann Steiner:
And for most people when they understand the idea, they think it's great, but it's a little bit like thinking it's a great idea to buy a burial plot, but nobody does. Most people don't do it, and one out of three Americans have a will. Everybody wants one. Everybody wants to have their wishes followed by their family, but the majority of us don't do it. So what I've been working on is trying to make it easy for people to set up a system. So going back to your question about the nuts and bolts, you referred to the bridge therapist. I think of it as having an emergency response team, like first responders in essence. That's a team of maybe five, depending how many people you want, but at least four of people that you trust, clinicians. And at the head of that is your emergency response coordinator or contact person, and that's the person you mentioned that I call the bridge therapist.
That's the person that if I'm in a car accident or I lose my voice, I call my bridge therapist and he or she knows where my calendar is, is able to cancel my patients for that week, has the keys to my... Right now, I'm now doing everything online out of my home office. So it has the keys to my locked file cabinet that has all the information that's spelled out in the actual professional will, and then you've got a system that's put together. So it's a team, I'm a group oriented person and I've found over the years that it works much better if you have this emergency response team that can then double also as a consultation group for you. If you're having knee surgery, you can talk to them and say, not can but is best, once you put them together, which is the hardest part of putting your team together, to be honest.
Elisabeth LaMotte:
Well, what would you say to somebody who says, I think I can identify a bridge therapist, but I'm not so sure about a team. I'm a solo practitioner. I've worked this way for years. Is it good enough if your practice is a manageable size to have one key bridge therapist?
Dr. Ann Steiner:
Great question. The issue is, when you say your practice is manageable enough, the question is, the bridge therapist is going to have to call all of your patients. So how many people in a week do you see? And this is looking at it being at a short term thing, so asking one therapist to call 25 patients...
Dr. Ann Steiner:
... in a week, in a day or two, is a lot. So why I like the idea of a bridge therapist with at least two people on your emergency response team, is that person can call the team together and then delegate out who's going to call who.
Dr. Ann Steiner:
It really makes it easier. So what used to be really hard, people said, "Well, there's nobody. I don't know the people in my community." Well, you can find them, and you can put together a temporary team just to have it going.
Elisabeth LaMotte:
As we reflect on this Dr. Steiner, and we talk about how important it is to have the professional will in place, to have the bridge therapist, and to have the emergency response team, could you share with our listeners what led you to become interested in this topic, and in fact, to become a real pioneer on this issue of professional wills, not just for social workers but for all clinicians?
Dr. Ann Steiner:
Well, there were several different paths. One was that I've had arthritis most of my life and it got worse after graduate school. And while I was in graduate school and during my postdoc, I got interested in the question of illness in the therapist. So I started researching it, and at that time, because I am a little bit old, at that time there was almost nothing. There was the very, very analytic, wonderful article by De Waal, which is a classic about illness in the therapist, but they're from a very analytic perspective. So there was almost no literature, and there was somebody who had written a professional will that was one or two pages, really didn't address all the little details that need to be addressed.