The majority of adults in the US living with mental illnesses are parents. However, service providers often express concern that they are not prepared to work with clients who are parents, feeling they lack the necessary tools and skills to identify and meet their needs. Let’s Talk About Parenting (LTP) supports providers to explore the experiences and impact of parenthood and family life on adult clients and to identify their goals and needs, keeping parenthood and family life in mind. LT-RP is an adaptation of the Finnish Let’s Talk model, an evidence-based psychosocial intervention to assist adult clients/parents with mental illness to identify and meet the needs of their children.
House Librarians as Instructors in a Self-Directed, Capstone-Related 3rd Year Flexible Clinical Experience Program
In academic year 2010/2011, the University of Massachusetts Medical School introduced a new, longitudinal, integrative curriculum (LiNC). One component of this new curriculum was the introduction of Learning Communities or "Houses.". Five Houses were formed to allow inter-class interaction, each that would serve as the medical student's academic and social home. A librarian from the Lamar Soutter Library was attached to each House. Two new components of the LiNC curriculum were a) a longitudinal, cumulative capstone project and b) a 3rd year Flexible Clinical Experience (FCE) program. The first was a natural fit for the House Librarians to interact with students as they conducted foundational research for their Capstone. The second was developed to allow students in their 3rd year an opportunity to choose a pre-designed elective or design their own clinical experience. One type of self-designed FCE is based in the library where students can spend one week conducting research towards their capstone project.
Beginning in academic year 2015/2016, students choosing the library-based FCE are formally required to work with their House Librarian. The librarians now act as the course supervisors. The students share their capstone proposals with their House Librarian and the librarians, in turn, provide comprehensive, library-based research experience, guide students to relevant resources, teach search techniques, and serve as library support for any library or research needs. Following each FCE, the students submit course evaluations. By the spring of 2016, there will be a significant number of evaluations from students that have completed the self-directed FCE with librarian supervision. The authors plan to review the FCE library-based course evaluations for the current year against those from when the House Librarians were not directly involved.
The capstone project can take many different forms, from a traditional research paper to a community outreach project to an artistic expression of medical education. But regardless of format, the capstone must consist of a scientific foundation, guided by evidence and grounded in a fundamental understanding of the literature. By comparing student evaluations responses from before and after formal librarian involvement, we hope to understand the impact librarians have had on capstone preparation, further adapt our methods to improve library integration into this component of the curriculum and explore ways to encourage more students to select the library-based FCE.
Because the library-based FCE now requires students to have direct supervision by their House Librarians, our goal is to use information gleaned from the student evaluations to learn how librarian immersion in this component of the curriculum can contribute to the success of both the self-designed FCE and capstone projects.
The Development of a Standardized Tool to Evaluate Physical Health Websites through the Lens of Persons with Serious Mental Illness
In 2015, the Lamar Soutter Library and the Department of Psychiatry at the University of Massachusetts Medical School received a grant from the National Library of Medicine to design an online tool that will provide persons with serious mental illness a means to acquire resources that will assist them in learning about co-morbidities often faced by this population. One of the first steps in creating this tool is to identify health-related websites that will meet strict quality measures applicable for use by our target audience. To facilitate this process, subject experts with skills in both mental health and physical health have been identified and will be asked to complete a comprehensive survey that will evaluate the identified websites. The survey will address aspects of each website reviewed such as content and credibility, format, usability and interactivity plus the evaluation of etiologic, diagnostic, therapeutic and/or prognostic information contained on the site. This poster will describe the evidence-based methodology used in developing and testing this survey instrument. Preliminary results, discussion of evaluative data and next steps will also be discussed.
Objective: To evaluate prehabilitation exercises to improve shoulder pain and abduction range of motion (ROM) after breast cancer surgery; to evaluate methods of exercise teaching; to assess postsurgical seroma formation.
Design: Pilot study
Setting: Academic medical center
Participants: 60 breast cancer patients were randomly assigned to either personal exercise instruction, group 1, n=36, or video only instruction, group 2, n=24.
Interventions: Shoulder exercises were assigned to both groups 1 month prior to surgery at an outpatient visit. Group 1 received personal instruction on exercises, plus written exercise instruction, and a link to access an online video. Group 2 received only written exercise instruction and a link to access the online video.
Main Outcome Measures: Exercise compliance, pain (via visual analog scale), shoulder abduction ROM (via goniometer), and presence or absence of seroma.
Results or Clinical Course: 76% of study patients chose to exercise. There was no difference in exercise compliance between personal instruction versus video teaching. (75%, 24/32 in-person vs. 77%, 10/13 video only, OR=1.03). 66% of patients (20/30) lost greater than 10 degrees shoulder abduction ROM at 1 month post surgery. 29% of patients (9/31) had worse shoulder pain at one month post surgery than at baseline (24%, 6/25 exercisers, and 50%, 3/6 non-exercisers). 15% of patients (4/27) had worse shoulder pain at 3 months post surgery than at baseline (8%, 2/25 exercisers, and 100%, 2/2 non-exercisers). Prehabilitation exercise program inferred no additional risk of seroma formation (21%, 7/33 exercisers vs. 22%, 2/9 non-exercisers OR=.94).
Conclusion: In-person teaching does not appear superior to video teaching for prehabilitation exercises in breast cancer. A high quality randomized controlled trial is necessary to assess efficacy of prehabilitation for improving post surgical outcomes. Prehabilitation exercises do not appear to increase risk of seroma formation in breast cancer surgery.
Case Diagnosis: On intake exam, patient reported twenty year history of shoulder pain and history of bilateral subacromial bursitis . On the day of the exam, she rated her left shoulder pain (ipsilateral to breast cancer) at 2/10. Physical exam showed tenderness over left subacromial bursa, pain with resisted shoulder abduction and external rotation and ROM limited 120 degrees or less bilaterally.
Case Description: Here, we report the case of a 73 year old woman with a 20 year history of bilateral subacromial bursitis and left shoulder pain who began an independent daily shoulder exercise regimen as instructed by a physiatrist 2.5 weeks prior to left sided lumpectomy for breast cancer, and continued the exercises following the operation. One month post-surgery, physical exam revealed no loss in range of motion (ROM) in flexion and abduction of the left and right shoulders. Patient reported intermittent pain, manageable with NSAIDs, which started only after tamoxifen use.
Discussion: Decline in physical functioning such as loss of ROM, decreased strength, and pain following surgery for breast cancer is a well-documented phenomenon associated with difficulties in performing activities of daily living (ADL). Studies have shown that rehabilitation interventions during treatment period following breast cancer surgery result in improvements in shoulder and arm function; however, no study to date investigated the effectiveness of interventions initiated before surgery (prehabilitation) for breast cancer.
Conclusions: A daily exercise regimen prior to and following lumpectomy for breast cancer may prevent the development of shoulder dysfunction that is often reported in the cancer treatment period.