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A needs assessment survey of 268 polio survivors residing in Maine explored the incidence of postpolio syndrome as well as perceived need for and access to social and health care services. A large proportion reported experiencing postpolio syndrome. Although knowledgeable of their condition, a majority perceived that they had no access to knowledgeable physicians or social and health care services and most were having difficulty coping. Findings indicate that polio survivors' self-appraisal of their illness status is related to their perceived need for and access to social and health care services. The need for community-based services, including medical, rehabilitative, educational, and social work services, is indicated., The success of modern medicine in preventing poliomyelitis has left both health care professionals and polio survivors largely unprepared to respond to late effects of the disease, which are now [...]

Data from 131 consecutive adult patients who underwent allogeneic bone marrow transplantation (BMT) at a tertiary care center from 1997 to 1999 suggest that the presence of an in-hospital lay care-partner during the patients' hospital stay is a powerful prognostic variable of survival. One year after the transplant, 75% of the patients with a lay care-partner were alive versus 26% of those without a care-partner. A multivariable survival analysis revealed not having an in-hospital lay care-partner as a significant independent risk factor for death (p <.001). This relationship held when adjusting for other such risk factors: i.e., primary diagnosis, disease status, and source of donor marrow. The idiosyncratic nature and importance of partnered relationships for survival in allogeneic BMT and the need to intervene and improve outcomes for patients are discussed with regard to future research and clinical programs. [ABSTRACT FROM AUTHOR]

A large number of Americans would rather rely on family and friends more than their physicians about end-of-life care and decisions. Moving beyond traditional clinical ethics and its dyadic focus on the physician-patient relationship, this article presents an approach to ethical decision-making at the end of life that is more inclusive of the patient's family and has the potential to advance social work practice in end-of-life care. Initial attention is given to how psychosocial and bioethical perspectives and practices interact to shape understanding of moral issues in end-of-life decisions. Morally relevant principles are then adapted from contextual therapy as being useful for including more of a family focus and viewing ethical decision-making at the end of life as a family process. Specifically, focus is on exploring the ethical dynamics of family systems that impact the decision-making process and translating psychosocial insight into ethical discussions that are supportive of families. The case of a patient with sudden and unexpected brain death and without advance directives demonstrates one family's unresolved grief and illustrates how its members were helped to reason morally about end-of-life choices. Contributions of a social worker and bioethicist are illustrated. [ABSTRACT FROM AUTHOR]

Objectives: The authors demonstrate the application of cognitive therapy in oncology care by presenting a brief review of theory and relevant case studies. Materials and methods: In light of the life and death nature of the fears evoked by cancer, it is important for the oncology clinician to recognize the role that cognition plays in patient responses to the diagnosis and treatment of cancer. After presentation of a theory base that creatively links cognition and the cancer experience, key cognitive concepts are defined and discussed. Case material illustrates the application of these concepts and how oncology clinicians can use select interventions adapted from the brief mental health treatment modality of cognitive therapy to promote adjustment to cancer. Results: Patient and family views about cancer have emotional and behavioral consequences, influence ability to cope with diagnosis and treatment, and serve to focus clinical intervention. Cognitive interventions can help patients and families think about cancer in objective, adaptive ways. Focusing on perceptions and questions of meaning, clinicians can be effective using cognitive lines of questioning that expand patient stories and elicit beliefs about cause, control, and responsibility for their cancer. Conclusions: Cognitive interventions are brief and solution-focused interventions that acknowledge and build on generalist interviewing skills common to each discipline. As such, they are particularly useful in physical health settings where work is fast paced and clinicians are faced with the challenge of dealing in a collaborative manner with patient and family coping responses as they apply to the medical problem and care plan. [ABSTRACT FROM AUTHOR]

Social workers, physicians, and nurses from a major urban teaching hospital were assessed and compared regarding their attitudes toward the rationing of health care. Responses to eighteen statements of considered moral judgments in the rationing of health care resources were analyzed in terms of levels of agreement with each. All three professional groups rejected rationing based on patient age and socioeconomic worth. However, social workers and physicians were more likely than nurses to consider such factors as cost-benefit ratios, quality of life, relative strength of a patient's moral claim, and scarcity of resources in rationing decisions. Study findings appear to portray social workers and physicians as being more utilitarian and nurses more egalitarian in rationing decisions. Implications for practice in a managed care environment are presented. [ABSTRACT FROM AUTHOR]

Hospital social workers (N = 255) from ten urban teaching hospitals in seven states were surveyed regarding their practice responses and training needs in bioethics. Responses to twenty-one practice situations in bioethics were analyzed in terms of levels of encountering ethical concerns, clinical participation and preparedness to handle ethical concerns. Whereas worker responses were greater in practice situations appearing more psychosocial than biomedical in nature, training needs were greater in those situations appearing more biomedical than psychosocial in nature. Rationing of health care, the number one training need across service specialities, stands out as the practice situation in which ethical concerns were encountered with the least preparation and participation. Prior training in ethical principles and analysis and service on a hospital ethics committee associated significantly with higher levels of worker responses. Implications for social work education and practice in today's health care environment are presented. [ABSTRACT FROM AUTHOR]

This narrative reflects on a paradigm case for understanding how in an era of managed care when values and economics appear so indivisible, one health care team united and provided non-costworthy care to a terminally ill patient who needed to live until the first day of the month. The ethical dilemma of treatment effect vs. treatment benefit in end of life decision making becomes a drama. The article chronicles events leading to the first day of the month and underscore the power of story and metaphor in creating common ground and common understanding in patient care. [ABSTRACT FROM AUTHOR]

A retrospective study of 82 elderly “failure to thrive” (FTT) inpatients suggests that FTT is diagnosed when the elderly patient's functional ability to live with multisystem diseases, cope with the ensuing problems, and manage his/her own care are remarkably diminished and no longer responsive to health care interventions. In an attempt to clarify the clinical picture of FTT, we used standardized questionnaires to abstract data from medical charts. [ABSTRACT FROM PUBLISHER]

Editorial. Focuses on cultural diversity in pediatrics. Ethical moments in pediatrics; Health care services; Patient stories; Assumptions about the nature of patients' conditions.