RESUMEN
The murder of George Floyd served as a catalyst to activate national outrage for the deaths of the many who preceded him, in the midst of the COVID-19 pandemic, has brought to light racial health disparities evident in our country and in our communities. While previous President's columns have included a call to action to engage with and improve the health care system, the glaring health inequities associated with COVID-19 and the Black Lives Matter movement implores deeper reflection. The author questions his role in maintaining the status quo, acknowledging health care disparities as a white male physician, and acknowledging his privilege and fragility. Complex emotions surrounding the COVID-19 pandemic are also discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
Asunto(s)
Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/psicología , Neumonía Viral/epidemiología , Neumonía Viral/psicología , Betacoronavirus , COVID-19 , Disparidades en Atención de Salud , Humanos , Pandemias , SARS-CoV-2RESUMEN
In previous President's Columns (Valeras, 2019a, 2019b), the properties of complexity and complex adaptive systems have been discussed, in terms of the value of continual and iterative change, in order to nudge a system to emerge differently, rather than maintain the status quo. COVID-19 is not a nudge; it is a tidal wave. Engaging with and understanding complexity science allows us to examine the internal rules of our health care system and recognize our own role as agents that can systematically and deliberately disrupt the status quo. The intertwined and interdependent complex relationships that exist in health care between persons, business, academia, and government buffer the system from rapid and drastic change. COVID-19, however, swiftly disrupted many of the rules keeping the system in its previous state. Some would describe this sudden and dramatic systems change as a Black Swan. This column will examine the role of the Black Swan, as it relates to this pandemic. The Black Swan is a term coined in the 2nd century by Roman poet Juvenal's description of something being rara avis in terries nigroque simillima cygno, Latin for "a bird as rare as the black swan" (Taleb, 2007, p. xxxi). At this time, reference to a black swan was meant as a statement of impossibility, because all historical records of swans had been white. In 1697, Dutch explorers discovered black swans living in the wild in Western Australia (Taleb, 2007, p. xxi), and the black swan became a metaphor for events that come as a surprise, have major implications, and can often be understood only with the benefit of hindsight. This theory of the black swan was further articulated by Nassim Nicholas Taleb in his books Fooled by Randomness (Taleb, 2001) and The Black Swan (Taleb, 2007). (PsycInfo Database Record (c) 2020 APA, all rights reserved).
Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/economía , Infecciones por Coronavirus/epidemiología , Pandemias/economía , Neumonía Viral/economía , Neumonía Viral/epidemiología , COVID-19 , Humanos , SARS-CoV-2RESUMEN
Referring to provider burn-out as a foe to be conquered is a palatable representation that fits within a familiar medical narrative-combating disease, fighting illness, curing and vanquishing the cancer. Even the words we use to describe our daily work-"on the front lines" or "in the trenches" or "fighting the good fight"-places us on a metaphorical battlefield. Is provider burn-out inflicted by another entity, and if so by whom or by what? Is it, by contrast, a disease or a condition? Is burn-out something that just happens or is it created? The World Health Organization International Classification of Disease (World Health Organization, 2019) added burn-out in 2019, but also made a clear statement that this is an occupational phenomenon and not a medical condition. It defines burn-out as "a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions: feelings of energy depletion or exhaustion; increased mental distance from one's job, or feelings of negativism or cynicism related to one's job; and reduced professional efficacy. Burn-out refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life" (WHO, 2019). (PsycInfo Database Record (c) 2020 APA, all rights reserved).
Asunto(s)
Agotamiento Profesional/etiología , Personal de Salud/psicología , Incertidumbre , Agotamiento Profesional/psicología , Humanos , Encuestas y Cuestionarios , Lugar de Trabajo/psicología , Lugar de Trabajo/normasRESUMEN
Presents a column from the presidents of the CHFA who discuss the current impacts of COVID-19 in the United States and in health care. The inconsistent, unscientific, and divisive response to the COVID-19 pandemic, and the racial inequality made evident by it, may serve historians and future leadership educators of what not to do in times of crisis, painful lessons that may be productive if we learn from our mistakes. The column then discusses the importance of racial and ethnic diversity within CHFA, workforce development, stragetic partnerships and policy. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Asunto(s)
COVID-19/epidemiología , Salud de la Familia , Liderazgo , Sociedades Médicas/organización & administración , Diversidad Cultural , Humanos , Pandemias , SARS-CoV-2 , Sociedades Médicas/normas , Desarrollo de Personal , Estados Unidos/epidemiologíaRESUMEN
In this column the author presents his thoughts on quality improvement (QI) as it relates to health care. Although the story of QI, combined with a drastic urgency for change, may have created the current state in its misapplication in health care, it is the QI tenets put forth by Deming that can redeem its promise. In this way, QI is a fractal, similar in makeup and application on various scales. This speaks to the universality of Deming's four tenets; the same tenets used for a successful QI project need to be employed in building the QI capacity of an organization (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Asunto(s)
Mejoramiento de la Calidad/clasificación , Mejoramiento de la Calidad/tendencias , Salud de la Familia , Humanos , Innovación OrganizacionalRESUMEN
This column notes that population health approaches have largely focused on the physical body outcomes and metrics, on disease registries, and on insurance claim information rather than measures that apply to whole person wellness (an integration of physical, mental, and spiritual health). There has been significant progress in recognizing that people's health is influenced by the context and systems in which they live. Parsing out the influence of context (social and behavioral determinants of health) and predominant physical disease processes is counter to the principles of systems thinking. It is only through examining and understanding the relationships between social and behavioral determinants of health, mental health, and physical health as three parts of a whole that meaningful gains might be achieved on an individual level as well as the population level. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Asunto(s)
Salud Poblacional , Análisis de Sistemas , HumanosRESUMEN
The previous President's Column explored Glouberman and Zimmerman's (2002) differentiation of complex problems versus those that fall under the domains of simple or complicated, concluding with an invitation to enter the fray for health care's future state (Valeras, 2019). In this second column on the subject of complexity, the author invites us to continue to explore the topic of complexity and embrace it within health care, rather than shy away from it, in order influence the future state. One tactic, when engaging with a complex adaptive system, is to ask Wicked Questions. Williamson (2015) defines Wicked Questions as what is used to to expose the assumptions which shape our actions and choices. Some of the Wicked Questions that can be asked regarding the U.S. health care system are discussed. Exploring complexity and complex adaptive systems may provide the way forward for the challenges we face in health care. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Asunto(s)
Atención Plena/métodos , Esperanza , Humanos , Satisfacción en el TrabajoRESUMEN
Einstein once said, "Everything must be made as simple as possible, but not one bit simpler." If the health care system continues to value and push oversimplified solutions to complex problems, we sacrifice context. We lose connection to the very system we seek to influence. We put at risk the very value Collaborative Family Healthcare Association (CFHA) was founded on-relationship. As CFHA celebrated its 20th annual conference as a change organization, we came together in Rochester, NY to reflect on two decades of work, innovation, and, above all, relationships-relationships with each other, with the communities we serve, and the health care systems we seek to improve. As Family, Systems, and Health pushes forward the field by taking on translational research, CFHA will as well. It has been CFHA's willingness to acknowledge complexity, through its emphasis on systems, that has distinguished this organization. We strive to improve ourselves, by coming together as a membership, learning from one another, pushing each other to emerge as individuals, to improve the care we provide. I look forward over the next 2 years to delve into the fray with you all. To explore together and discover your approach to the complex problems we face. What we do is not rocket science; it's far more complex! (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Asunto(s)
Atención a la Salud/tendencias , Empatía , Congresos como Asunto , Conducta Cooperativa , HumanosRESUMEN
Oxidative injury and the resulting death of neurons is a major pathological factor involved in numerous neurodegenerative diseases. However, the development of drugs that target this mechanism remains limited. The goal of this study was to test a compound library of approved Food and Drug Administration drugs against a hydrogen peroxide-induced oxidant injury model in neuroblastoma cells. We identified 26 neuroprotective compounds, of which megestrol, meclizine, verapamil, methazolamide, sulindac, and retinol were examined in greater detail. Using large-scale oligonucleotide microarray analysis, we identified genes modulated by these drugs that might underlie the cytoprotection. Five key genes were either uniformly upregulated or downregulated by all six drug treatments, namely, tissue inhibitor of matrix metalloproteinase (TIMP1), ret-proto-oncogene, clusterin, galanin, and growth associated protein (GAP43). Exogenous addition of the neuropeptide galanin alone conferred survival to oxidant-stressed cells, comparable to that seen with the drugs. Our approach, which we term "interventional profiling," represents a general and powerful strategy for identifying new bioactive agents for any biological process, as well as identifying key downstream genes and pathways that are involved.