Being a career musician is typified by high risk. Despite low earnings, many musicians pursue their careers driven by self-belief, high expectations, and optimism. However, failure to obtain the ...success many optimistically aspire to has been seen to pose psychosocial risks relating to mental health conditions such as anxiety and depression. While studies have shown dispositional optimism as having many health-related benefits, it has also been conceptualized negatively in encouraging a tendency toward loss-making in one key area: gambling. In this article, we develop the argument that the risks of professional music-making are analogous to gambling, and the optimism displayed by many aspiring career musicians may therefore represent a form of what Berlant calls cruel optimism, with negative effects on mental health and wellbeing. In doing so, we draw on Berlant’s theoretical position to examine the potentially harmful intersections between risk-taking behaviors and creative desire. Drawing also on our clinical experience, we consider when and how musicians who are emotionally struggling with their work might find it advantageous to reorient their careers, or even withdraw from the labor market altogether, to support their health and wellbeing, and the challenges around the loss of identity these can present.
The National Comprehensive Cancer Network (NCCN) Best Practices Committee created an Advanced Practice Provider (APP) Workgroup to develop recommendations to support APP roles at NCCN Member ...Institutions.
The Workgroup conducted three surveys to understand APP program structure, staffing models, and professional development opportunities at NCCN Member Institutions.
The total number of new and follow-up visits a 1.0 APP full-time equivalent conducts per week in shared and independent visits ranged from 11 to 97, with an average of 40 visits per week (n = 39). The type of visits APPs conduct include follow-up shared (47.2%), follow-up independent (46%), new shared (6.5%), and new independent visits (0.5%). Seventy-two percent of respondents utilize a mixed model visit type, with 15% utilizing only independent visits and 13% utilizing only shared visits (n = 39). Of the 95% of centers with APP leads, 100% indicated that leads carry administrative and clinical responsibilities (n = 20); however, results varied with respect to how this time is allocated. Professional development opportunities offered included posters, papers, and presentations (84%), leadership development (57%), research opportunities (52%), writing book chapters (19%), and other professional development activities (12%; n = 422). Twenty percent of APPs indicated that protected time to engage in development opportunities should be offered.
As evidenced by the variability of the survey results, the field would benefit from developing standards for APPs. There is a lack of information regarding leadership structures to help support APPs, and additional research is needed. Additionally, centers should continuously assess the career-long opportunities needed to maximize the value of oncology APPs.
Empirical investigations into the development of children's understanding of emotion can contribute to greater understanding of the cognitive and affective systems involved. In this article, we ...review studies that examined children's ability to recognize emotional information in facial expressions and their knowledge of ways this information is affected by aspects of the situations in which the expressions occur. The presentation of the empirical findings is organized around a discussion of the methodological basis of the research. Consistent findings are identified and modifications of the assessment procedures that may alleviate some of the methodological problems and extend the external validity of future studies are suggested.
This article describes how trust among team members and in the technology supporting them was eroded during implementation of an electronic health record (EHR) in an adult outpatient oncology ...practice at a comprehensive cancer center. Delays in care of a 38-year-old woman with high-risk breast cancer occurred because of ineffective team communication and are illustrated in a case study. The case explores how the patient's trust and mutual trust between team members were disrupted because of inaccurate assumptions about the functionality of the EHR's communication tool, resultant miscommunications between team members and the patient, and the eventual recognition that care was not being effectively coordinated, as it had been previously. Despite a well-established, team-based culture and significant preparation for the EHR implementation, the challenges that occurred point to underlying human and system failures from which other organizations going through a similar process may learn. Through an analysis and evaluation of events that transpired before and during the EHR rollout, suggested interventions for preventing this experience are offered, which include: a thorough crosswalk between old and new communication mechanisms before implementation; understanding and mitigation of gaps in the communication tool's functionality; more robust training for staff, clinicians, and patients; greater consideration given to the pace of change expected of individuals; and development of models of collaboration between EHR users and vendors in developing products that support high-quality, team-based care in the oncology setting. These interventions are transferable to any organizational or system change that threatens mutual trust and effective communication.
Senior executive nursing roles demand excellence and rigor in both the technical and interpersonal domains of leadership. Many nurse leaders have begun seeking innovative self-development programs ...and practices to assist them as they strive to improve their effectiveness as leaders in complex organizations. One practice that has gained in popularity is that of engaging a leadership "coach." To understand this relatively new trend in healthcare leadership, the authors interviewed 4 coaches and 4 nurse leaders who had been coached. In this article, they present their overall findings about the effectiveness of coaching as a leadership development tool and offer recommendations for leaders who are interested in engaging a coach.
Abstract
Background
Bacillus cereus can cause serious nosocomial infections, including neuroinvasive infections in immunocompromised patients. Three patients with AML developed hospital-onset ...neuroinvasive B. cereus infections in close temporal proximity at our institution in 2022, triggering an extensive epidemiological investigation.
Methods
We identified all patients with AML, positive microbiologic assays for Bacillus species >48 hours after admission, and neurological symptoms with radiologic findings admitted between January 2018 and October 2022 (Figure 1). Infection control practices were observed, environmental samples obtained, and a dietary case-control study was performed. Bacillus isolates were sequenced, including 2 case isolates, 61 environmental specimens, and 19 samples of a protein supplement common to most AML patients.Figure 1.Case Identification and Definitions
Results
Five AML patients with B. cereus neuroinvasive disease were identified. Four were identified via blood culture and one via metagenomic sequencing of plasma cell-free DNA. All patients were hospitalized for induction chemotherapy and were neutropenic (Table 1; Figure 2). Central nervous system findings included intraparenchymal and subarachnoid hemorrhage, and rim-enhancing lesions. All patients were treated with ciprofloxacin and survived without neurologic sequelae. B. cereus was positively identified in 7/61 environmental and 1/19 protein samples. There was no single exposure common to all patients per the dietary case-control study, hospital construction records, or environmental samples. Sequencing confirmed all isolates were unrelated. Ciprofloxacin was added to the empiric antimicrobial regimen for AML patients with neutropenic prolonged or recurrent fevers in September 2022; no new cases have since been identified through April 2023 (Figure 3).Table 1.Clinical Characteristics of Neuroinvasive Bacillus Cereus CasesFigure 2.Timeline of Clinical Presentation of Neuroinvasive Bacillus Cereus InfectionFigure 3.Antimicrobial Protocol for Prevention of Neuroinvasive Bacillus Cereus Infection
Conclusion
B. cereus is ubiquitous in the hospital environment, sometimes leading to pseudoclusters with unrelated isolates. Fastidious infection control practices addressing a broad range of potential exposures are warranted to prevent nosocomial infections. Including B. cereus coverage in empiric regimens for AML patients with prolonged or recurrent neutropenic fever may prevent serious infections from this pathogen.
Disclosures
Nicolas C. Issa, MD, AiCuris: Grant/Research Support|Astellas: Grant/Research Support|Boehringer Ingelheim: Advisor/Consultant|Fujifilm: Grant/Research Support|GSK: Grant/Research Support|Merck: Grant/Research Support|Moderna: Grant/Research Support Chanu Rhee, MD, MPH, Cytovale: Advisor/Consultant|Pfizer: Advisor/Consultant|UpToDate, Inc.: Honoraria Michael Klompas, MD, MPH, UpToDate, Inc.: Royalties for chapters on pneumonia
Zusammenfassung
Die Erreichbarkeit einer hohen Usability sowie User Experience in Softwareprodukten setzt ein detailliertes Verständnis über Benutzer und deren Aufgaben voraus. Daher bilden ...Anforderungsdokumente für die Aktivitäten von Usability Experten eine wichtige Arbeitsgrundlage. Aber auch für die Aufgaben anderer Rollen wie Softwarearchitekten und Tester bilden diese Dokumente eine wichtige Informationsquelle. Dies bringt jedoch die Herausforderung mit sich, dass in Anforderungsdokumenten unterschiedliche Informationsbedarfe adressiert werden müssen, was deren Nutzbarkeit für die einzelnen Rollen negativ beeinflusst. Um geeignete Lösungen für dieses Problem zu entwickeln, ist empirisch fundiertes Wissen über Informationsbedarfe eine unabdingbare Voraussetzung. In diesem Beitrag werden Aufbau und Ergebnisse erster Studien vorgestellt, welche Informationsbedarfe an Anforderungsdokumente aus Sicht von Usability Experten untersucht haben. Dabei konnten erste Erkenntnisse hinsichtlich der Relevanz von Artefakten wie Beschreibungen von Endnutzern und Interaktionen gewonnen werden. Unterschiede innerhalb der Teilnehmergruppe, insbesondere im Hinblick auf den Detaillierungsgrad der relevanten Artefakte erfordern weitere Studien, welche Einflussfaktoren auf Informationsbedarfe genauer untersuchen.
Die Erreichbarkeit einer hohen Usability sowie User Experience in Softwareprodukten setzt ein detailliertes Verständnis über Benutzer und deren Aufgaben voraus. Daher bilden Anforderungsdokumente für ...die Aktivitäten von Usability Experten eine wichtige Arbeitsgrundlage. Aber auch für die Aufgaben anderer Rollen wie Softwarearchitekten und Tester bilden diese Dokumente eine wichtige Informationsquelle. Dies bringt jedoch die Herausforderung mit sich, dass in Anforderungsdokumenten unterschiedliche Informationsbedarfe adressiert werden müssen, was deren Nutzbarkeit für die einzelnen Rollen negativ beeinflusst. Um geeignete Lösungen für dieses Problem zu entwickeln, ist empirisch fundiertes Wissen über Informationsbedarfe eine unabdingbare Voraussetzung. In diesem Beitrag werden Aufbau und Ergebnisse erster Studien vorgestellt, welche Informationsbedarfe an Anforderungsdokumente aus Sicht von Usability Experten untersucht haben. Dabei konnten erste Erkenntnisse hinsichtlich der Relevanz von Artefakten wie Beschreibungen von Endnutzern und Interaktionen gewonnen werden. Unterschiede innerhalb der Teilnehmergruppe, insbesondere im Hinblick auf den Detaillierungsgrad der relevanten Artefakte erfordern weitere Studien, welche Einflussfaktoren auf Informationsbedarfe genauer untersuchen.
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