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Chest pain is a common nonspecific symptom that patients may endorse in the postoperative setting, with potential causes ranging from benign to medical emergencies. Acute myocardial injury is the most [...], Background: The incidence of adverse perioperative cardiac complications after parathyroidectomy has not been well described. This study aimed to evaluate the incidence of perioperative chest pain and cardiac complications after parathyroidectomy and to evaluate risk factors that may identify patients who are more likely to benefit from a cardiac workup. Methods: We performed a retrospective study of all patients undergoing parathyroidectomy for primary hyperparathyroidism by a single endocrine surgeon at a tertiary endocrine centre between 2011 and 2018. Patient demographics, clinicopathologic variables, operative and postoperative details (reported chest pain, performance of a cardiac workup and new postoperative cardiac diagnosis) were reviewed. Patients with chest pain were compared to those without chest pain using the Fisher exact test and Student t test. Results: Fourteen of 295 patients (4.7%) reported chest pain in the immediate postoperative period. Most patients were investigated with a 12-lead electrocardiogram and troponin (n = 12/14), yet none were diagnosed with a cardiac event. When comparing patients with and without chest pain, there was no significant difference in age, gender, body mass index, presence of cardiovascular risk factors, American Society of Anesthesiologists score or length of surgery. Conclusion: Postoperative chest pain after parathyroidectomy is not an uncommon event and leads to a cardiac workup in most cases; however, the risk of significant postoperative cardiac events is minimal. In the "choosing wisely" era, one should evaluate each patient&apos;s pretest probability of such events and avoid extensive workup in low-risk patients to avoid unnecessary costs to the health care system. Contexte : L&apos;incidence des complications cardiaques périopératoires après la parathyroïdectomie n&apos;a pas été bien décrite. Cette étude visait à évaluer l&apos;incidence des douleurs rétrosternales (DRS) et des complications cardiaques périopératoires après la parathyroïdectomie et à analyser les facteurs de risque qui permettraient d&apos;identifier les patients les plus susceptibles de bénéficier d&apos;une batterie d&apos;examens cardiaques. Méthodes : Nous avons procédé à une étude rétrospective sur tous les patients ayant subi une parathyroïdectomie pour hyperparathyroïdie primaire effectuée par un seul spécialiste en chirurgie endocrinienne d&apos;un centre de soins tertiaires d&apos;endocrinologie entre 2011 et 2018. Nous avons passé en revue les caractéristiques démographiques et clinico-pathologiques des patients et certaines données per- et postopératoires (DRS, résultats des examens cardiaques et diagnostic postopératoire nouveau de cardiopathie). À l&apos;aide du test exact de Fisher et du test t de Student, nous avons comparé les patients selon qu&apos;ils avaient ou non présenté des DRS. Résultats : Quatorze patients sur 295 (4,7%) se sont plaints de DRS durant la période postopératoire immédiate. La plupart (n = 12/14) ont alors subi un électrocardiogramme à 12 dérivations et un dosage de la troponine, et aucun n&apos;a reçu de diagnostic de cardiopathie. La comparaison entre les patients ayant ou non présenté des DRS n&apos;a fait ressortir aucune différence quant à l&apos;âge, au sexe, à l&apos;indice de masse corporelle, aux facteurs de risque cardiovasculaires, au score de l&apos;American Society of Anesthesiologists et à la durée de la chirurgie. Conclusion : Les DRS postopératoires ne sont pas rares après la parathyroïdectomie et dans la plupart des cas, elles donnent lieu à des batteries d&apos;examens pour le coeur, alors que le risque de graves complications cardiaques postopératoires est minime. En cette époque où il faut << choisir avec soin >>, on doit évaluer la probabilité de survenue de tels événements chez chaque patient et s&apos;abstenir de demander des examens trop poussées chez ceux qui ont un risque faible afin de réduire les coûts superflus pour le système de santé.

Family of origin relationships are an important influence on career decision-making. The current study investigates the relationship between family cohesion, expressiveness and conflict and dysfunctional career thoughts. The Family Environment Scale-Form R (Moos & Moos, 2009) measured the family environment and the Career Thoughts Inventory (Sampson, Peterson, Lenz, Reardon, & Saunders, 1996) measured dysfunctional career thoughts. Participants were undergraduate students at a large Southern University. The results found that higher levels of family conflict and lower levels of family expressiveness were associated with higher levels of decision-making confusion, commitment anxiety, and external conflict. Implications for career counselors are discussed.

Purpose: We sought to understand the experiences of family members and direct care staff of adults with intellectual and developmental disabilities in a private pay day program focused on socialization and recreational skills. Method: Two focus groups were held with parents/caregivers and one with staff. Using an interpretive method, two investigators independently coded the transcripts and arrived at themes. Results: Themes identified included transition, lack of information, lack of resources, caregiver needs, independence, employment, and education. Conclusion: Families and staff experienced frustration with service fragmentation/access to alternative programming. Families and staff wanted opportunities for employment and independent living programming but lacked resources. Implications for practice and policy are discussed

Purpose: The purpose of this pilot study was to compare the work value preferences of individuals with disabilities with the work value preferences for a sample of individuals without disabilities. Methods: The preferred work values of a sample of vocational rehabilitation consumers were compared to workers employed in a Southeastern university. Results: Results indicated that vocational rehabilitation consumers preferred Independence and Support while workers in the general population preferred Recognition and Relationships. No differences were found with respect to Achievement and Working Conditions. Conclusions: This study provides evidence that there are differences between persons with disabilities and the general population with respect to preferred work values. Rehabilitation counselors should assist the consumer in securing employment where there is congruence in work environment and preferred work values.

Although research supports a relationship between work and psychological factors, one area not studied is the relationship between preferred career value and psychological factors. This study investigated the relationship between preferred career values and psychological problems for individuals with disabilities. Career values have been shown to have an important impact on vocational outcomes. The results indicated that a preference for Independence, Recognition, Achievement, and Relationships were associated with clinical levels of psychological problems. Implications for rehabilitation counselors are discussed.

Purpose: The primary purpose of this study was to investigate whether there were differences between European and African American vocational rehabilitation consumers' perceptions of the barriers they experience towards obtaining employment. A secondary purpose was to determine whether there were differences in these perceptions based upon gender or educational background. Method: The perceived barriers to employment success of 189 consumers of a state-federal vocational rehabilitation agency were evaluated using the Barriers to Success Inventory (BESI) between 2004-2007. Univariate (ANOVA) and multivariate analysis of variance (MANOVA) were used to investigate the effects of three independent variables (gender, ethnicity and educational background) on five dependent variables. The five dependent variables include the BESI Personal and Financial scale, the Emotional and Physical scale, the Career Decision-Making and Planning scale, the Job-Seeking and Knowledge scale, and the Training and Education scale. Results: The results indicate that African American consumers perceived significantly more barriers to obtaining a job or succeeding in employment than their Euro-American counterparts for all five dependent scale variables. Conclusions: African American participants' primary perceived barriers relate to practical matters, such as having sufficient education or training for the type of job sought, childcare, transportation, medical care, housing, and financial resources. (Contains 4 tables.)

Purpose: The purpose of the current study is to investigate the relationship between career readiness, defined as capability and complexity, and vocational identity for individuals with disabilities. Method: Forty-three consumers participating in vocational evaluation services for a state-federal vocational rehabilitation agency completed the Career Thoughts Inventory (CTI) and My Vocational Situation (MVS). Regression analysis was used to investigate the relationship between two independent variables (complexity and capability) and vocational identity. Results: The results indicated that the independent variables (complexity and capability) accounted for 52% of the variance of the MVS--Vocational Identity score. Partial eta square for complexity was 0.03 (small effect) and for capability 0.46 (large effect). Conclusions: The results of the study provide support that improving career readiness contributes to improved vocational identity defined as the individual having a clearer and more stable understanding of their career goals, interests, personality, and talents. The Career Thoughts Inventory can be used by a vocational rehabilitation counselor to differentiate an individual's level of career readiness and develop targeted career interventions.

Access to health insurance is one of the critical aspects of securing employment for people with disabilities. This study investigated whether vocational rehabilitation consumers secured employment with an employer who offered health insurance at similar rates to workers in the general population. In general, the results show that vocational rehabilitation consumers had significantly lower health insurance access rates than workers in the general population. Implications for rehabilitation counselors are discussed. (Contains 1 table.)

A national study of rehabilitation counseling graduate students and state-federal rehabilitation counselors investigated whether there were differences between (a) what graduate students preferred to do upon graduation and what they believed vocational rehabilitation counselors did, (b) what graduate students preferred to do upon graduation and what vocational rehabilitation counselors perceived they did, and (c) what students believed vocational rehabilitation counselors did and what counselors perceived they did. Results indicated graduate students preferred to spend more time on counseling and less time on case management than state-federal vocational rehabilitation counselors perceived they did. Graduate students were accurate in their estimates of the amount of time vocational rehabilitation counselors stated they spent on counseling and inaccurate in their estimates of time spent on case management. Implications for recruitment and retention of rehabilitation counseling graduate students are discussed. (Contains 2 tables.)

Although research suggests why disability may cause poverty, it is not well understood why poverty may cause disability. This article presents the Poverty Disability Model, which includes four groups of factors that increase the risk that poverty will cause disability and chronic health problems. Rehabilitation interventions and counselor implications derived from the model are presented in addition to research.

In this study, the authors examined whether individuals with disabilities report higher levels of trauma symptoms than their nondisabled counterparts. Based on trauma theory and prior research regarding the incidence rate of posttraumatic stress disorder, the authors hypothesized that individuals with disabilities would report higher levels of trauma symptoms. Results partially supported the hypothesis, with women with disabilities reporting significantly higher levels of recalled trauma symptomatology when compared with men with disabilities and with men and women without disabilities. Men with disabilities did not report significantly higher levels of trauma symptoms when compared with men and women without disabilities. Effect sizes and confidence intervals were also computed for each analysis.

Knowledge of traumatic events and how trauma symptoms relate to social and psychological well-being continues to grow. One aspect of an individual's functioning that may be affected by exposure to traumatic events is the ability of the individual to engage in career-and work-related activities (D. H. Coursol, J. Lewis, & L. Garrity, 2001). The current study examines the relationship between trauma symptoms and the career development process of 131 college students. Results indicate a significant relationship between higher levels of trauma symptoms and higher levels of dysfunctional career thoughts and lower levels of work personality. Implications for career counselors are discussed. (Contains 3 tables.)

In the current study, the authors examined whether the influence of trauma symptomatology on select career variables differs based on disability status. A total of 131 college students and 81 individuals with disabilities completed the "Career Thoughts Inventory," "My Vocational Situation," "Developmental Work Personality Scale," and "L.A. Symptom Check-list." The authors then conducted multiple regressions to examine interaction terms. These terms were not significant, suggesting that the influences of trauma clusters did not differ according to groups. Disability status made the largest unique contribution on all career variables. Among the trauma symptom clusters, Avoidance/Numbness had the broadest impact, with unique contributions on all of the career variables except CTICA.

This study investigated the relationship between perceived changes in sense of coherence from pre- to postinjury and adjustment for a group of individuals with spinal cord injury. It was hypothesized that after a spinal cord injury, an individual's belief that he or she had significantly reduced his or her sense of coherence would be associated with reduced adjustment. Forty-eight individuals with spinal cord injury completed Antonovsky's Sense of Coherence Scale and Livneh and Antonak's Reactions to Impairment and Disability Inventory. Results indicated a positive relationship between adjustment and strengthened sense of coherence. Rehabilitation counselor implications are discussed.

Understanding consumers' concerns about vocational rehabilitation services is important because of the current emphasis on empowerment and consumer-directed services. This study focused on participants' responses to an open-ended survey question that asked them what they thought could be done to improve their satisfaction with a vocational rehabilitation program. Participants were employed and unemployed consumers of vocational rehabilitation services. The responses were analyzed using a form of qualitative content analysis. The analysis resulted in the development of four categories: concerns about general counseling skills, concerns about program-specific counseling skills, concerns about treatment outside of counseling sessions, and concerns about education and employment. The implications of the findings for program improvement and counselor training are also discussed.

Examines the impact of sense of coherence in the career thought processes of a sample of college students. Participants completed the Sense of Coherence Scale and the Career Thoughts Inventory (CTI). Results indicated a medium relationship between sense of coherence and CTI Total and subscale scores. (Contains 29 references and 2 tables.) (GCP)

Study looked at the working alliance between rehabilitation counselors and clients. Analysis of survey results indicated that a) employed clients had a stronger working alliance than unemployed clients, and b) the working alliance is related to the client's perception of future employment prospects and his/her satisfaction with the current job. Implications for rehabilitation counselors are discussed. (Contains 35 references, 1 table and 1 appendix.) (ADT)