The conundrum of cryptogenic cirrhosis: Adverse outcomes without treatment options

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How to diagnose amyloidosis

Amyloidosis is a rare but devastating condition caused by deposition of misfolded proteins as aggregates in the extracellular tissues of the body, leading to impairment of organ function. High clinical suspicion is required to facilitate early diagnosis. Correct identification of the causal amyloid protein is absolutely crucial for clinical management in order to avoid misdiagnosis and inappropriate, potentially harmful treatment, to assess prognosis, and to offer genetic counselling if relevant. This review summarises the current evidence on which the diagnosis and subtyping of amyloidosis is based, outlines the limitations of various diagnostic techniques, particularly in an Australian and New Zealand context, and discusses optimal strategies for the diagnostic approach to these patients. Recommendations are provided for when particularly to suspect amyloidosis, what investigations are required, as well as an approach to accurate subtyping of amyloidosis.     

Motherhood and Work–Life Balance in the National Collegiate Athletic Association Division I Setting: Mentors and the Female Athletic Trainer

Context:

One of the greatest catalysts for turnover among female athletic trainers (ATs) is motherhood, especially if employed at the National Collegiate Athletic Association Division I level. The medical education literature regularly identifies the importance of role models in professional character formation. However, few researchers have examined the responsibility of mentorship and professional role models as it relates to female ATs'' perceptions of motherhood and retention.

Objective:

To evaluate perceptions of motherhood and retention in relation to mentorship and role models among female ATs currently employed in the collegiate setting.

Design:

Qualitative study.

Setting:

Female athletic trainers working in National Collegiate Athletic Association Division I.

Patients or Other Participants:

Twenty-seven female ATs employed in the National Collegiate Athletic Association Division I setting volunteered. Average age of the participants was 35 ± 9 years. All were full-time ATs with an average of 11 ± 8 years of clinical experience.

Data Collection and Analysis:

Participants responded to questions by journaling their thoughts and experiences. Multiple-analyst triangulation and peer review were included as steps to establish data credibility.

Results:

Male and female role models and mentors can positively or negatively influence the career and work–life balance perceptions of female ATs working in the Division I setting. Female ATs have a desire to see more women in the profession handle the demands of motherhood and the demands of their clinical setting. Women who have had female mentors are more positive about the prospect of balancing the rigors of motherhood and job demands.

Conclusions:

Role models and mentors are valuable resources for promoting perseverance in the profession in the highly demanding clinical settings. As more female ATs remain in the profession who are able to maintain work–life balance and are available to serve as role models, the attitudes of other women may start to change.Key Words: role models, retention, quality of life

Key Points

• Role models and mentors are being identified by female athletic trainers working in the Division I setting.
• Perceptions of work–life balance can be positively affected by how role models and mentors maintain balance within their own lives. Conversely, those individuals who cannot maintain balance can negatively affect their proteges'' perceptions of work–life balance.
• Female athletic trainers working in the Division I setting desire more female role models who are effectively balancing the multiple responsibilities of their personal and professional lives.

The positive and negative influences of role models and mentors have been well established in the medical literature, specifically in academic medicine.^1–3 In a published systematic review of the literature,¹ mentorship in academic medicine was reported to enhance personal and career development, as well as research productivity, including publications and grant awards. Mentoring was described in the late 1970s by Levinson,⁴ who exposed the relationship as one of the most significant influences an individual can have in early adulthood. Mentoring has been emphasized as a critical element for personal and career advancement and career selection.^1,2 However, mentoring is not always a positive experience. Repeated negative learning experiences may adversely affect the development of professionalism in medical students and residents.⁵ A lack of mentoring may contribute to career success deficiencies in academic medicine, especially for women.^1,3 Furthermore, female physicians are less likely than their male colleagues to identify role models for work–life balance (WLB).⁶Role models and mentors differ in that mentors are senior members of a group who intentionally encourage and support younger colleagues in their careers.⁵ Mentoring often includes role modeling. A role model teaches predominantly by example and helps to form one''s professional identity and commitment by promoting observation and comparison.⁵ Role modeling is less intentional, more informal, and more episodic than mentoring. Individuals serving as supervisors are the gatekeepers to establishing an environment that enhances a family-friendly atmosphere and ensures that their employees realize WLB. Work–life balance is attained when an individual''s right to a contented life inside and outside paid work is accepted and valued as the norm. Mazerolle et al⁷ found that head athletic trainers (ATs) informally try to encourage WLB through role modeling. Therefore, supervisors and bosses may incidentally act as role models.Of great concern in the field of athletic training is the subject of retention among female ATs, which has recently been heavily researched.^8–11 The departure of female ATs from the profession has been theoretically linked to the desire to strike a balance between family obligations and personal time with work responsibilities.^12,13 The National Collegiate Athletic Association Division I clinical setting holds unique professional challenges for ATs. Long road trips, nights away from home, pressure to win, supervision of athletic training students, infrequent days off, high athlete-to-AT ratios, athletes on scholarship, and extended competitive seasons are some of the stresses faced by an AT working in the Division I setting.¹⁴ Concerns regarding WLB and time for parenting influence decisions to persist at the collegiate level.^12,13 Several investigators^11,13 in athletic training have suggested that motherhood is a primary factor leading to the departure of females from the profession. Role models and mentoring have emerged as possible factors to aid in the retention of females in the collegiate setting once they become mothers.Limited research on mentoring exists in the context of athletic training. Two studies^15,16 have examined the effects of professional socialization among high school and collegiate ATs. Similar to mentoring, professional socialization is a process by which individuals learn the knowledge, skills, values, roles, and attitudes associated with their professional responsibilities.¹⁷ The mentoring roles of ATs evolve over their careers. Initially, ATs make network connections in order to learn, but as they become more experienced, they take on more of a mentoring role. This occurs as a result of being contacted by less experienced colleagues for advice on how to deal with problems in their clinical settings.¹⁶ Additionally, a recent study¹⁸ examined female athletic training students'' perceptions on motherhood in the athletic training profession; the students felt strongly that a female mentor who had children would greatly benefit them personally as well as professionally. Though the students named mentorship as an important retention factor, they had very limited direct mentorship from a female AT with children employed in the collegiate setting. This finding mirrors research in the medical literature⁶ highlighting a lack of role models or mentors being identified by females in various professions. Although Pitney¹⁶ highlighted the presence of mentors in the athletic training profession, a scarcity of information exists regarding the part mentors and role models play for female ATs specifically and in their influence on WLB views. The purpose of our study, therefore, was to examine the effect of role models and mentors on perceptions of career and motherhood among female ATs working in the Division I setting. This study will be the first to assess perceptions of mentors and role models among female ATs throughout the life experience spectrum (single, married, married with children). The following central research question guided this study: how do role models and mentors within athletic training influence female ATs employed in the Division I setting?