Male Chaplains and Female Soldiers: Are There Gender and Denominational Differences in Military Pastoral Care?

In this study, 15 United States Army chaplain men described the practices they engaged in when providing pastoral support to women soldiers. Many engaged in creating safe spaces for women and themselves, particularly in regard to avoiding perceptions of impropriety. Other clergy did not consider gender a factor in counseling. Some chaplains placed limitations on the amount of support they would give. This study did not determine the degree to which chaplain men were effective.

The Comprehensive Female Soldier Support Model.

Women represent a small minority in the U.S. military and an even smaller minority in the military chaplaincy. Prior to this study, the U.S. Army chaplaincy did not have a gender-specific model for providing support to women soldiers. In this Delphi research project, wounded women soldiers and female military chaplains provided expert opinions to develop the comprehensive female soldier support model (CFS2). Ten military women and 11 female chaplains who had been deployed overseas contributed to the body of knowledge related to the understanding of the emotional and spiritual support needs of wounded female soldiers. Five key findings appeared in the study: (a) many women did not get the chaplain support they needed; (b) the gender of the chaplain was not significant;

Resident and hospitalist perspectives on the "great teaching case": Correlation with actual patient assignment decisions.

BACKGROUND: With the advent of limits to resident duty hours and the size of teaching services, many academic institutions have introduced nonteaching services, often triaging perceived better teaching cases to the resident services. OBJECTIVE: To compare resident versus faculty perceptions of ideal cases for teaching services and compare these perceptions with actual triage decisions made by faculty who assigned patients to either teaching or nonteaching services. DESIGN: Residents and hospitalist faculty were surveyed about their perceptions of ideal and actual teaching admissions, first with qualitative, open-ended questions and then with quantitative, specific questions generated from responses to the first survey. Characteristics of patients admitted to teaching and nonteaching services were analyzed retrospectively and compared with resident and faculty perceptions. RESULTS: Residents and faculty agreed that rare cases, patients with unique physical findings, and a variety of pathology were ideal for teaching services and that social admissions, benefactors, and patients with chronic or functional pain were not. Residents believed that traditional ("bread and butter") medicine cases were under-represented on the teaching services. Although residents perceived that they received a disproportionate number of older patients, outside transfers, patients with chronic pain, and patients with cancer, the only statistically significant difference was in patient age, with the teaching service actually receiving younger patients (66.7 vs 69.3 years; P=0.008). CONCLUSIONS: Residents and faculty have similar views about ideal teaching cases, but a triage system based on perceived educational merit creates the possibility of resident misperceptions about their case mix, even if patients are distributed relatively equitably.

A national comparison of burnout and work-life balance among internal medicine hospitalists and outpatient general internists.

BACKGROUND: General internists suffer higher rates of burnout and lower satisfaction with work-life balance than most specialties, but the impact of inpatient vs outpatient practice location is unclear. METHODS: Physicians in the American Medical Association Physician Masterfile were previously surveyed about burnout, depression, suicidal ideation, quality of life, fatigue, work-life balance, career plans, and health behaviors. We extracted and compared data for these variables for the 130 internal medicine hospitalists and 448 outpatient general internists who participated. Analyses were adjusted for age, sex, hours worked, and practice setting. RESULTS: There were 52.3% of the hospitalists and 54.5% of the outpatient internists affected by burnout (P = 0.86). High scores on the emotional exhaustion subscale (43.8% vs 48.1%, P = 0.71) and on the depersonalization subscale (42.3% vs 32.7%, P = 0.17) were common but similar in frequency in the 2 groups. Hospitalists were more likely to score low on the personal accomplishment subscale (20.3% vs 9.6%, P = 0.04). There were no differences in symptoms of depression (40.3% for hospitalists vs 40.0% for outpatient internists, P = 0.73) or recent suicidality (9.2% vs 5.8%, P = 0.15). Rates of reported recent work-home conflict were similar (48.4% vs 41.3%, P = 0.64), but hospitalists were more likely to agree that their work schedule leaves enough time for their personal life and family (50.0% vs 42.0%, P = 0.007). CONCLUSIONS: Burnout was common among both hospitalists and outpatient general internists, although hospitalists were more satisfied with work-life balance. A better understanding of the causes of distress and identification of solutions for all internists is needed.

Burnout in inpatient-based versus outpatient-based physicians: a systematic review and meta-analysis.

BACKGROUND: Burnout is a syndrome affecting the entirety of work life and characterized by cynicism, detachment, and inefficacy. Despite longstanding concerns about burnout in hospital medicine, few data about burnout in hospitalists have been published. PURPOSE: A systematic review of the literature on burnout in inpatient-based and outpatient-based physicians worldwide was undertaken to determine whether inpatient physicians experience more burnout than outpatient physicians. DATA SOURCES: Five medical databases were searched for relevant terms with no language restrictions. Authors were contacted for unpublished data and clarification of the practice location of study subjects. STUDY SELECTION: Two investigators independently reviewed each article. Included studies provided a measure of burnout in inpatient and/or outpatient nontrainee physicians. DATA EXTRACTION: Fifty-four studies met inclusion criteria, 15 of which provided direct comparisons of inpatient and outpatient physicians. Twenty-eight studies used the same burnout measure and therefore were amenable to statistical analysis. DATA SYNTHESIS: Outpatient physicians reported more emotional exhaustion than inpatient physicians. No statistically significant differences in depersonalization or personal accomplishment were found. Further comparisons were limited by the heterogeneity of instruments used to measure burnout and the lack of available information about practice location in many studies. CONCLUSIONS: The existing literature does not support the widely held belief that burnout is more frequent in hospitalists than outpatient physicians. Better comparative studies of hospitalist burnout are needed.

Hyperammonemic Coma in an Adult due to Ornithine Transcarbamylase Deficiency.

Objective. To report an unusual cause of coma in an adult. Design. Case report. Setting. University teaching hospital. Patient. A previously healthy 53-year-old man initially presented with altered mental status and progressed to coma. He was found to be substantially hyperammonemic and did not improve with lactulose therapy and continuous venovenous hemodialysis. Results. Biochemical testing revealed previously undiagnosed ornithine transcarbamylase deficiency, and the patient responded to arginine, sodium phenylacetate, and sodium benzoate. Conclusion. Even in adult patients with no known history, inborn errors of metabolism must be considered in the differential diagnosis of unexplained coma. Defects of the urea cycle can present with an unprovoked hyperammonemic coma.

The portrayal of migraine in popular music: observations and implications.

OBJECTIVE: To describe the manner in which migraine and migaineurs are depicted in popular music. BACKGROUND: Prior studies have elucidated the ways in which the popular perception of neurological disorders is shaped by popular culture, from the inflated expectations of the prognosis of coma patients in television dramas to the association of intractable headaches with demonic possession and death by violence in the cinema. METHODS: searched popular online music sites for songs with the word "migraine" in their titles. Song lyrics were studied for tone, content, and the light in which they portrayed migraine sufferers. RESULTS: One hundred thirty-four songs met inclusion criteria, representing the work of 126 artists. The majority of the recording artists were male (112 of 126 artists, 89%). One hundred seven of the 134 songs (80%) were recorded since 2000. Of the 79 songs that contained lyrics, 16 (20%) included explicit content; 43 (54%) make reference to hopelessness, despair, or severe pain; and 27 (34%) contained references to killing or death. Only 9 songs (11%) made any reference to successful treatment, resolution, or hope of any sort, the same number that made lyrical references to explosions or bombs. CONCLUSIONS: The portrayal of a disease in popular music can reflect the artist's perceptions, anxieties, and prejudices about the disease and its victims. The public, including patients, may accept these portrayals as accurate. Clinicians familiar with the portrayal of headache sufferers in cinema will not be surprised that popular musicians (both migraineurs and non-migraineurs) portray migraines as intractable, violent, and all-consuming. The lack of any balancing view is disheartening, especially in light of the advances in migraine awareness and treatment over the past decade. Perhaps the most surprising finding is that the vast majority of migraine songs are written and performed by men.

Management of inpatient hyperglycemia: assessing perceptions and barriers to care among resident physicians.

OBJECTIVE: To develop insight into resident physician attitudes about inpatient hyperglycemia and determine perceived barriers to optimal management. METHODS: As part of a planned educational program, a questionnaire was designed and administered to determine the opinions of residents about the importance of inpatient glucose control, their perceptions about what glucose ranges were desirable, and the problems they encountered when trying to manage hyperglycemia in hospitalized patients. RESULTS: Of 70 resident physicians from various services, 52 completed the survey (mean age, 31 years; 48% men; 37% in first year of residency training). Most respondents indicated that glucose control was "very important" in critically ill and perioperative patients but only "somewhat important" in non-critically ill patients. Most residents indicated that they would target a therapeutic glucose range within the recommended levels in published guidelines. Most residents also said they felt "somewhat comfortable" managing hyperglycemia and hypoglycemia and using subcutaneous insulin therapy, whereas most residents (48%) were "not at all comfortable" with use of intravenous administration of insulin. In general, respondents were not very familiar with existing institutional policies and preprinted order sets relating to glucose management. The most commonly reported barrier to management of inpatient hyperglycemia was lack of knowledge about appropriate insulin regimens and how to use them. Anxiety about hypoglycemia was only the third most frequent concern. CONCLUSION: Most residents acknowledged the importance of good glucose control in hospitalized patients and chose target glucose ranges consistent with existing guidelines. Lack of knowledge about insulin treatment options was the most commonly cited barrier to ideal management. Educational programs should emphasize inpatient treatment strategies for glycemic control.