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moral injury

Joel Hoffman, Belinda Liddell, Richard A Bryant, Angela Nickerson
BACKGROUND: Refugees are often exposed to multiple traumatic experiences, leading to elevated rates of psychological disorders. There is emerging evidence that appraisals of traumatic events as violating deeply held moral beliefs and frameworks (i.e., moral injury) impact negatively on refugee mental health. Despite this, no research has systematically investigated moral injury appraisals in refugees. METHOD: Participants were 222 refugees from diverse backgrounds who had recently resettled in Australia...
August 10, 2018: Depression and Anxiety
Kent D Drescher, Joseph M Currier, Jason A Nieuwsma, Wesley McCormick, Timothy D Carroll, Brook M Sims, Christine Cauterucio
This study examines VA chaplains' understandings of moral injury (MI) and preferred intervention strategies. Drawing qualitative responses with a nationally-representative sample, content analyses indicated that chaplains' definitions of MI comprised three higher order clusters: (1) MI events, (2) mechanisms in development of MI, and (3) warning signs of MI. Similarly, chaplains' intervention foci could be grouped into three categories: (1) pastoral/therapeutic presence, (2) implementing specific interventions, and (3) therapeutic processes to promote moral repair...
August 9, 2018: Journal of Religion and Health
Leandro Castaneyra-Ruiz, Diego M Morales, James P McAllister, Steven L Brody, Albert M Isaacs, Jennifer M Strahle, Sonika M Dahiya, David D Limbrick
Intraventricular hemorrhage (IVH) is the most common cause of pediatric hydrocephalus in North America but remains poorly understood. Cell junction-mediated ventricular zone (VZ) disruption and astrogliosis are associated with the pathogenesis of congenital, nonhemorrhagic hydrocephalus. Recently, our group demonstrated that VZ disruption is also present in preterm infants with IVH. On the basis of this observation, we hypothesized that blood triggers the loss of VZ cell junction integrity and related cytopathology...
July 18, 2018: Journal of Neuropathology and Experimental Neurology
Yonit Schorr, Nathan R Stein, Shira Maguen, J Ben Barnes, Jeane Bosch, Brett T Litz
OBJECTIVE: Service members deployed to war are at risk for moral injury, but the potential sources of moral injury are poorly understood. The aim of this qualitative study was to explore the types of events that veterans perceive as morally injurious and to use those events to develop a categorization scheme for combat-related morally injurious events. METHOD: Six focus groups with US war veterans were conducted. RESULTS: Analysis based on Grounded Theory yielded two categories (and eight subcategories) of events that putatively cause moral injury...
July 9, 2018: Journal of Clinical Psychology
Elizabeth Troutman Adams, Elisia L Cohen, Andrew Bernard, Whittney Darnell, Donald W Helme
Prescription opioids and heroin account for more than half of all drug overdose fatalities, costing an estimated 115 American lives every day. The ongoing opioid epidemic devastates communities and represents a tremendous burden to the national economy and health care system. In 2016, the Centers for Disease Control and Prevention and the White House Office of National Drug Control Policy proposed action to train prescribers on the proper dispensing of opioids, which are indispensable pharmacologic resources for treating acute pain resulting from a traumatic injury or surgery...
July 1, 2018: Qualitative Health Research
Tine Molendijk
The last decade has witnessed fast-growing scholarly interest in the concept of moral injury, which addresses the link between the ethics of military intervention and deployment-related suffering. However, current research on moral injury, predominantly psychological in nature, tends to approach the phenomenon as an internally contained disorder. Consequently, it medicalizes moral injury and de-contextualizes it from the people who send soldiers to conflict zones and 'welcome' them back. This article addresses the ways in which the experience of moral injury is embedded in and shaped by public debates on military intervention, drawing on relevant literature from the fields of psychology, philosophy, and social sciences, and on in-depth qualitative interviews collected in 2016 and 2017 with 80 Dutch veterans...
August 2018: Social Science & Medicine
Enrique Morales-Orcajo, Ricardo Becerro de Bengoa Vallejo, Marta Losa Iglesias, Javier Bayod, Estevam Barbosa de Las Casas
The aim of the present study is to examine the impact absorption mechanism of the foot for different strike patterns (rearfoot, midfoot and forefoot) using a continuum mechanics approach. A three-dimensional finite element model of the foot was employed to estimate the stress distribution in the foot at the moment of impact during barefoot running. The effects of stress attenuating factors such as the landing angle and the surface stiffness were also analyzed. We characterized rear and forefoot plantar sole behavior in an experimental test, which allowed for refined modeling of plantar pressures for the different strike patterns...
July 3, 2018: Computer Methods in Biomechanics and Biomedical Engineering
Esther Murray, Charlotte Krahé, Danë Goodsman
BACKGROUND: The term 'moral injury' may be useful in conceptualising the negative psychological effects of delivering emergency and prehospital medicine as it provides a non-pathological framework for understanding these effects. This is in contrast to concepts such as burnout and post-traumatic stress disorder which suggest practitioners have reached a crisis point. We conducted an exploratory, pilot study to determine whether the concept of moral injury resonated with medical students working in emergency medicine and what might mitigate that injury for them...
June 26, 2018: Emergency Medicine Journal: EMJ
Rajiv Singh, Ayşe A Küçükdeveci, Klemen Grabljevec, Alan Gray
The increasing complexity of healthcare provision and medical interventions requires collaboration between large numbers of health professionals. The nature of the interactions between team members determines whether the pattern of working is described as multi-, inter- or trans-disciplinary. Such team-working is an important part of the specialty of Physical and Rehabilitation Medicine. Grounded in group behaviour theory, team-working demonstrates that joint aims, trust and willingness to share knowledge, can improve patient outcomes, including mortality...
June 26, 2018: Journal of Rehabilitation Medicine
Lucely Cetina-Pérez, Alberto Serrano-Olvera, Laura Flores-Cisneros, Roberto Jiménez-Lima, Cristina Alvarado-Silva, María Del Consuelo Díaz-Romero, Flavia Morales-Vásquez, David Eduardo Muñoz-González, Aida Mota-García, Oscar Armando Chávez-Fierro, Silvia Cristina Jaramillo-Manzur, Jaime de la Garza-Salazar, Denisse Castro-Eguiluz, Abelardo Meneses-García
Mexico has seen an increase in cancer prevalence in its entire population as well as particular age ranges, predominantly the older segment. The most frequently reported pelvic cancers in Mexico are cervical, endometrial, bladder, prostate, rectum, and anal canal. Approximately 80% of the population diagnosed with pelvic cancers present with locally advanced tumors and require concomitant chemoradiotherapy, sequential chemoradiotherapy, or radiotherapy alone. The toxicity of any of these treatment modalities may be manifested as intestinal injury, a significant problem that can compromise the response to treatment, the patient's nutritional state, quality of life, and survival...
2018: Revista de Investigación Clínica; Organo del Hospital de Enfermedades de la Nutrición
Natalie Gofman, Kim To, Marc Whitman, Edgar Garcia-Morales
PURPOSE: A patient with carbapenem-resistant Klebsiella pneumoniae infection is described, and treatment options are discussed. SUMMARY: Few antibiotics to treat carbapenem-resistant Enterobacteriaceae (CRE) infection are available, and treatment is further complicated by the limited ability of many antibiotics to penetrate into the cerebrospinal fluid (CSF). Currently, there is a lack of clinical data on the treatment of central nervous system CRE infections, and therapy is based on case reports, case series, and small retrospective studies...
July 1, 2018: American Journal of Health-system Pharmacy: AJHP
Daniel Ospina-Delgado, Laura Marcela Mosquera Salas, Alejandro Enríquez-Marulanda, Jaime Hernández-Morales, Robinson Pacheco, Javier Lobato-Polo
OBJECTIVE: This study aims to describe cases of traumatic brain injury due to gunshot wounds in civilian population over 18 years of age, treated at a referral hospital in Cali, Colombia and compare the clinical outcomes at discharge. METHODS: An observational, descriptive cross-sectional study was conducted by retrospectively collecting clinical data related to adult patients that presented traumatic brain injury due to civil gunshot-wounds and that consulted to the emergency room at Fundación Valle del Lili Hospital in Cali, Colombia between January 2010 and February of 2016...
June 19, 2018: Neurocirugía
Francisco Ismael Villarreal-García, Pedro Martin Reyes-Fernández, Oscar Armando Martínez-Gutiérrez, Víctor Manuel Peña-Martínez, Rodolfo Morales-Ávalos
Introduction: Stab-wound injuries to the spinal cord are rare and currently, do not have a well-established management in the literature despite its strong association with neurological injury. Case presentation: We report a case of a patient with a stab-wound injury with a knife in the lumbar region, who underwent direct removal in the operating room without surgical exploration. Upon admission, the patient had no neurological deficit. The X-rays and CT scan before removal showed the involvement of >50% of the intramedullary canal at L2...
2018: Spinal Cord Series and Cases
Donna Ames, Zachary Erickson, Nagy A Youssef, Irina Arnold, Chaplain Sam Adamson, Alexander C Sones, Justin Yin, Kerry Haynes, Fred Volk, Ellen J Teng, John P Oliver, Harold G Koenig
Introduction: There is growing evidence that moral injury (MI) is related to greater suicide risk among Veterans and Active Duty Military (V/ADM). This study examines the relationship between MI and suicide risk and the moderating effect of religiosity on this relationship in V/ADM with post-traumatic stress disorder (PTSD) symptoms. Materials and Methods: This was a cross-sectional multi-site study involving 570 V/ADM from across the USA. Inclusion criteria were having served in a combat theater and the presence of PTSD symptoms...
June 15, 2018: Military Medicine
Jesús A Morales-Gómez, Everardo Garcia-Estrada, Jorge E Leos-Bortoni, Miriam Delgado-Brito, Luis E Flores-Huerta, Adriana A De La Cruz-Arriaga, Luis J Torres-Díaz, Ángel R Martínez-Ponce de León
OBJECTIVE Cranioplasty implants should be widely available, low in cost, and customized or easy to mold during surgery. Although autologous bone remains the first choice for repair, it cannot always be used due to infection, fragmentation, bone resorption, or other causes, which led to use of synthetic alternatives. The most frequently used allogenic material for cranial reconstructions with long-term results is polymethylmethacrylate (PMMA). Three-dimensional printing technology has allowed the production of increasingly popular customized, prefabricated implants...
June 15, 2018: Journal of Neurosurgery
Chad M Teven, Lawrence J Gottlieb
Burn injuries raise questions about decision-making capacity, informed consent, medical decision making, patient autonomy, the patient-physician relationship, and medical futility that must be acutely addressed. A commonly used approach to managing ethical challenges focuses on moral principles including respect for patient autonomy, beneficence, nonmaleficence, and justice. Another paradigm for ethical analysis is the "four-quadrant" approach, which poses questions for a given case regarding medical indications, patient preferences, quality of life, and contextual features...
June 1, 2018: AMA Journal of Ethics
Penny S Reynolds
The success of Tactical Combat Casualty Care (TCCC) in reducing potentially preventable combat deaths may rely on both specific interventions (such as tourniquets) and the systematized application of immediate care. Essential elements of a combat care system include clear specification of immediate care priorities, standardized methodology, and inclusion and training of all nonmedical personnel in early response. Although TCCC is fairly recent, the construct is similar to that first suggested during the mid-nineteenth century by John Turner Caddy (1822-1902), a British Royal Navy staff surgeon...
December 0: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
Gerard Hastings
We have discovered the elixir of life. For the first time in human existence we now know how we can avoid disease, make our lives healthier and more fulfilled, and even fend off the grim reaper himself (at least for a while). We may not have joined the immortals - many traps and snares continue to prey on us - but we are beginning to learn some of their secrets. Why then are we failing to grasp these heady opportunities? WHO data show that nine out of ten of we Europeans are dying of lifestyle diseases; that is diseases caused by our own choices - self-inflicted diseases...
June 2018: Scandinavian Journal of Public Health
Jose A Moral-Munoz, Bernabe Esteban-Moreno, Enrique Herrera-Viedma, Manuel J Cobo, Ignacio J Pérez
Body balance disorders are related to different injuries that contribute to a wide range of healthcare issues. The social and financial costs of these conditions are high. Therefore, quick and reliable body balance assessment can contribute to the prevention of injuries, as well as enhancement of clinical rehabilitation. Moreover, the use of smartphone applications is increasing rapidly since they incorporate different hardware components that allow for body balance assessment. The present study aims to show an analysis of the current applications available on Google Play StoreTM and iTunes App StoreTM to measure this physical condition, using the Mobile Application Rating Scale (MARS)...
May 29, 2018: Journal of Medical Systems
Ruth M J Byrne, Shane Timmons
Five experiments identify an asymmetric moral hindsight effect for judgments about whether a morally good action should have been taken, e.g., Ann should run into traffic to save Jill who fell before an oncoming truck. Judgments are increased when the outcome is good (Jill sustained minor bruises), as Experiment 1 shows; but they are not decreased when the outcome is bad (Jill sustained life-threatening injuries), as Experiment 2 shows. The hindsight effect is modified by imagined alternatives to the outcome: judgments are amplified by a counterfactual that if the good action had not been taken, the outcome would have been worse, and diminished by a semi-factual that if the good action had not been taken, the outcome would have been the same...
May 26, 2018: Cognition
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