What Is Performance Medicine in Clinical Practice?

Posted on by Joseph Gerard

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Written by Elissa Capelle Vaughn

When we think of medicine, often the first thing that springs to mind is “illness.” From this perspective, patients visit a doctor when they have a symptom, like a persistent pain or stomach bug. But on the other side of this approach is medicine as a proactive tool, and that’s where performance medicine comes in.   

Performance medicine is an integrative practice that combines sports medicine, functional medicine, and even anti-aging studies to enhance well-being. It also appeals to multiple patients, from athletes who want to achieve peak health to individuals who want targeted care for longevity.

When paired with traditional general healthcare, performance medicine fosters a truly holistic approach to health. Here’s a closer look at core components, comparisons, practices, and case studies of performance medicine.       

 

Performance Medicine vs. Internal Medicine

Let’s start with distinguishing the similarities and differences between performance medicine and internal medicine.

For starters, both practices strictly rely on evidence-based care. Internal medicine treats illnesses and health conditions, but like performance medicine, it also focuses on:

  • Prevention
  • Nutrition
  • Sleep
  • Diagnostics
  • Lifestyle changes

Both practices share the same goal in improving long-term health outcomes and reducing the risk of injury. Performance medicine practitioners and general physicians both conduct comprehensive assessments, including: 

  • Lifestyle evaluations
  • Hormone levels
  • Metabolic health 

Of course, both physicians maintain high levels of trust with patients to foster the best possible outcomes.    

As for key differences, while internal medicine does involve preventative care, it’s also a “reactive” process that must diagnose and treat symptoms quickly. Performance medicine is a “proactive” practice that enhances physical and mental performance, such as:

  • Adaptive capacity
  • Endurance
  • Mental acuity
  • Stamina
  • Longevity

Patient segments also differ, with performance medicine generally targeting individuals with low health risks who want to enhance their health. 

An athlete may seek out a performance medicine practice to boost their endurance or mental grit. Active older adults may also work with a performance medicine doctor to manage the impacts of aging through peptide therapy and weight management. 

Women in general good health may also take a proactive approach and seek a performance medicine clinic for menopause care. While an internal medicine physician can help the same female patient manage menopause symptoms, a performance medicine professional can help balance hormones and promote healthy metabolism.  

 

Performance Medicine vs. Sports Medicine

At first glance, the term “performance medicine” may be confused with sports medicine, but there are distinct differences.

Let’s start with the similarities, with the clearest being strength and endurance, followed by: 

  • Proactive injury prevention
  • Nutrition
  • Health monitoring

For example, a sports medicine doctor will also monitor hormone levels, nutrition, and musculoskeletal health to improve performance and prevent burnout. Monitoring also speaks to the level of individualized care seen in performance medicine, as well. 

One of the clearest differences is “return to play” care. 

Sports medicine is primarily concerned with treating sports injuries and getting professional and collegiate athletes back on the field. Sports medicine doctors often work in teams to answer whether an athlete can jump, throw, and sprint again, and if so, when?

Depending on the severity of a sports injury, a sports medicine team may require surgical or orthopedic treatments.   

As such, sports medicine patients are primarily athletes. Performance medicine targets a wider range of patient profiles, from the high-level executive managing corporate stress to the mother who’s navigating perimenopause while trying to keep up with a busy household.

A valuable takeaway is that sports medicine has a narrower, short-term approach to resilience, while performance medicine focuses on long-term resilience.   

It should also be noted that many performance medicine doctors do train in sports medicine, internal medicine, or physical medicine & Rehabilitation (PM&R) before entering their chosen field. They may pursue performance medicine as a sub-specialization through a sports medicine fellowship, for example.    

 

Performance Medicine vs. Medical Spas

Performance medicine also shares similarities with medical spas (medspas), with notable differences.  

A common similarity is an integrative approach, as seen in the case study of Moonshot Medical and Performance, a medical optimization and physical rehabilitation clinic. Similar to some medspas, this case study integrates the following approaches into weight management programs: 

  • GLP-1 medications
  • Nutrition guidance
  • Dual-Energy X-ray Absorptiometry (DEXA) scans

DEXA scans are comprehensive health reports that compare patient results with appropriate age and sex ranges. Patients see a more accurate view of fat and muscle distribution. DEXA tracking is then used to develop plans and monitor progress. 

It’s important to note that performance medicine clinics apply strict medical scrutiny in practice. This is a key differentiator between performance medicine clinics like the case study and some medspas. 

For instance, a general wellness center may offer massage therapy, but lack the medical oversight to provide GLP-1 plans. Similarly, while many medical spas do offer weight loss management, they may not have an on-site physician to diagnose and prescribe a GLP-1 like Semaglutide. 

Anti-aging treatments are another overlap. 

For example, the performance medicine clinic in the case study provides peptide-based therapy for anti-aging. Peptides are naturally occurring amino acids in the body; therapeutic peptides like GHK-CU mimic natural peptide signals to simulate the collagen synthesis process, promoting skin elasticity and hair growth.   

A medical spa may offer peptide anti-aging therapies with the right medical oversight. However, most spas focus on cosmetic treatments like dermal fillers and skin resurfacing. Performance medicine takes a more rigorous inside-out approach to health and wellness.

Performance medicine clinics may vary when it comes to treatments, with some offering cold plunges to relieve inflammation, while others may focus on HRT treatments for hormone balance. However, the goal of medical optimization remains unchanged. 

 

Blood Panels and Labwork in Performance Medicine  

Similar to internal medicine, performance medicine clinics run bloodwork to get a clearer picture of a patient’s health status. However, performance medicine labwork looks beyond statistical averages based on population data. Instead, it looks at optimal health ranges to set benchmarks. 

Consider this scenario: A patient visits their doctor, a general physician, citing issues with fatigue and longer recovery times from muscle strain. 

The GP runs a blood panel, revealing testosterone levels on the lower end and cortisol levels on the higher end, but these levels are still within the “normal” range, despite the rise and falls. The GP may tell the patient that their levels are normal and likely to balance out. 

The patient decides to see a performance medicine physician. 

The physician looks at the blood panel and sees the subclinical dysfunction in the testosterone and cortisol levels. They create a treatment plan consisting of bioidentical hormone therapy (BHRT) and targeted stress mitigation to restore the patient’s anabolic drive, which should help the body build and repair tissue while controlling hormones. 

Lab-informed decision-making is a core pillar of performance medicine.

Performance medicine physicians order advanced blood panels that test beyond the standard 15 markers used by internal medicine. Advanced panels test over 60 biomarkers, including: 

  • ApoB for cardiovascular health risk
  • Fasting insulin for metabolic health
  • Sex hormone metabolites

Meanwhile, genetics and epigenetics tests offer important insight into genetic predispositions. This allows performance medicine practitioners to customize targeted lifestyle interventions early. 

 

Data Analysis in Performance Medicine

Blood tests provide valuable patient data for treatment plans, but continuous monitoring ensures that data is current and relevant. 

Performance medicine doctors perform objective blood re-testing and DEXA scans every few months to analyze treatment progress. For instance, if lipid levels remain unchanged, they may administer PCSK9 Inhibitors.  

Biometric dashboards are used to monitor the autonomic nervous system (ANS), which regulates involuntary processes, such as: 

  • Resting heart rate (RHR)
  • Heart rate variability (HRV)
  • Respiratory Rate
  • Blood Pressure 
  • Sudomotor Function (Sweat Response)

Patient-reported outcomes (PROMs) are also vital to data analysis in performance medicine. These digital surveys ensure data actually aligns with a patient’s daily life, tracking patterns in sleep quality, mental clarity, and pain impact.

 

Rehabilitation and Recovery in Performance Medicine

In internal medicine, a patient’s physical therapy treatment typically ends once they’re able to perform daily tasks and go to work without pain. If they want to improve their strength beyond their PT sessions, they can see a performance medicine doctor for targeted strength and endurance regimens.  

For instance, a practitioner may use load management techniques to stress the patient’s tissues just enough to improve muscle adaptation. The goal is to strengthen the muscle without re-injuring the area. But the ultimate goal is greater resilience, lowering overall injury risk.

Performance medicine also takes an active, rather than passive, approach to recovery. A doctor may recommend contrast therapy, which combines infrared sauna sessions and cold plunges to: 

  • Promote better vascular health
  • Detoxify the system 
  • Trigger norepinephrine release
  • Reduce overall inflammation

Hyperbaric oxygen therapy (HBOT) is also used in performance medicine to speed up healing and cellular repair in the body, treating the whole person.

All three of these methods help downregulate the nervous system and flush out metabolic waste.

 

Learn More About Performance Medicine

Performance medicine stands out as an integrative practice that considers the whole person, whether it’s a patient who wants to build up strength after physical therapy, a woman entering menopause, or a busy corporate professional trying to reduce toxic stress. 

Research further into its similarities and differences with other practices, clinical tests, data analysis, and recovery. Our blog is packed with information on sectors, career pathways, and innovations in the healthcare community. 

Author bio:

Elissa Capelle Vaughn is a New York-based content writer who covers trending topics in health and wellness. She also brings a diverse background in sales and marketing to her work when discussing communication strategies in the health field.

 

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AIHCP: Marriage and Family Therapy Blog

Posted on by Mark Moran

Marriage and Family Therapy

Marriage and Family Therapy has a variety of schools of thought on how best to help families come together and form healthy bonds

Marriage and family therapy has become a growing area of study and practice. It treats many relationships and mental health problems. Therapists learn methods to match their work to the specific needs of every client. Articles from Australia and other countries show that proven methods matter. These studies check how well therapy styles work. For example, a review looks at many studies. It compares what they found to show that family therapy methods work well when researchers test them using strict rules. Systemic family and couples therapy (SFCT) is flexible and works for many conditions. It has benefits that traditional therapy for one person does not have. This text begins a look at types of marriage and family therapy. It shows how methods help people heal and grow their relationships.(Evans P et al., 2012). Additionally, systemic family and couples therapy (SFCT) has garnered attention for its adaptability and proven success across multiple conditions, showcasing its distinct advantages over traditional individual-centered therapies (Stratton P, 2011). This introduction lays the groundwork for a deeper exploration of the types of marriage and family therapy, aiming to illuminate the practices that effectively foster relational healing and growth.

Please also review AIHCP’s Healthcare Certifications as well as its Behavioral Health Certifications in grief, crisis, anger, stress, trauma and spiritual counseling.

Definition of marriage and family therapy

Marriage and family therapy (MFT) is a special field of mental health care. It looks at how family members interact with each other in their daily lives. This practice uses a system-based model. It shows how personal problems often start from family patterns or social surroundings. MFT improves communication and solves conflicts between people. It helps family members act in healthy ways. These changes help everyone feel better emotionally in the end. Many studies show that different types of family therapy work well. They help address family problems and mental health struggles (). Systemic family and couples therapy (SFCT) is a well-known type of MFT. It is different from standard therapy. It focuses on how people relate to each other instead of just looking at one person. Research proves that SFCT works and people accept it. It is a good tool for many different health issues (). This evidence supports using it in modern clinics. These facts show that MFT helps build healthy families.(Evans P et al., 2012)). Systemic family and couples therapy (SFCT), a prominent form of MFT, diverges from traditional therapy by focusing on relational interactions rather than individual pathology. The research surrounding SFCT confirms its effectiveness and acceptability, establishing it as a valuable resource for a broad array of conditions, thus justifying its integration into contemporary therapeutic practices ((Stratton P, 2011)). This underscores the importance of MFT in fostering healthier familial environments.

Importance of therapy in maintaining healthy relationships

Therapy helps people keep their relationships healthy. It gives individuals and couples a set place to work through hard feelings. People use different methods like cognitive-behavioral therapy and emotionally focused therapy. In these sessions, people learn better ways to talk and grow their emotional intelligence. They also fix deep problems that might hurt their bond. For instance, studies show that therapy greatly cuts down on fights. It makes partners happier, and they understand and respect each other more. Regular sessions help prevent future trouble. Partners get tools to handle stress and fights. They stop these issues from getting worse. A review of relevant studies in Australia and other countries proves this fact today. This review looked at how well different family therapy methods worked in recent years. Partners make therapy a top priority to keep their bond healthy. This choice shows they invest in their own emotional well-being and happiness. Stronger and more resilient bonds grow from this investment. These bonds survive the many hard times in life.(Evans P et al., 2012)(Evans P et al., 2012). By prioritizing therapy as a means of preserving relational health, partners invest in their emotional well-being, ultimately leading to stronger, more resilient partnerships that can thrive amidst life’s challenges.

Overview of different types of therapy approaches

Marriage and family therapists need a deep understanding of many different ways to help their clients. These various methods meet many relationship needs and difficult situations. For example, systemic family therapy looks at the whole family unit. It examines the way family members interact instead of only looking at one person. Reports show this way of working creates strong positive results for hard relationship problems. It is a key tool in modern therapy work. Using mixed methods that take parts from many styles can improve how well treatment works and keep people involved. This shows a shift toward care that fits each person. Research shows that contemporary therapy uses many different tools. A close look at studies shows these ways work well for managing difficult family bonds. These facts show that therapists must stay flexible during their therapy work.(Stratton P, 2011). Additionally, the use of integrative methods that combine elements from multiple therapeutic modalities can enhance treatment effectiveness and engagement, reflecting a trend towards more personalized care. The literature indicates that contemporary practices draw on a range of strategies, and a thorough review of relevant studies underscores the efficacy of these various approaches in addressing the complexities of familial relationships (Evans P et al., 2012). Such insights highlight the importance of adaptability in therapeutic intervention.

Structural Family Therapy

Family therapists work to help families or couples better communicate and resolve differences. Please also review AIHCP’s Healthcare Certifications

Structural Family Therapy (SFT) is a key method in the field of marriage and family therapy. It focuses on family organization and how people interact. SFT looks at the parts of family systems to define small groups and make boundaries clear. This work is necessary to help family members build healthier relationships. This method works well for various clinical problems. Research shows it works for a wide range of conditions. This data shows the method is acceptable and low cost to use in clinical practice. Structural Couple Therapy (SCT) uses SFT rules for couples to fix relationship problems. It offers practical steps that help partners talk and solve problems together. SFT gives a basic way to understand family life. It acts as a flexible tool to improve the health of relationships in various situations.(Stratton P, 2011). Moreover, when applied to couples, Structural Couple Therapy (SCT) integrates the principles of SFT to specifically target relational dysfunctions, offering practical interventions that facilitate communication and problem-solving between partners (George M Simon). Therefore, SFT not only provides a foundational understanding of family dynamics but also serves as a versatile framework for improving relational health within various contexts.

Core principles and therapeutic goals

Effective marriage and family therapy relies on certain core principles and therapeutic goals. These ideas guide experts who help families build better and healthier relationships. One main idea focuses on how family members interact as a system. We cannot look at one person’s actions alone, so we look at larger patterns inside the home. This method is the base for family and couples therapy. Research shows these methods work well, and clients find them acceptable for many different problems. Therapy goals include better talk, fixing fights, and setting clear rules between family members. These goals show why couples must work together as one unit. Therapists use these rules to build a safe and supportive space. This space helps people understand each other and work together. This work leads to long-lasting changes in how people treat one another. These core principles act as more than just a plan for treatment. They also offer a map for reaching long-term growth in relationships.(Stratton P, 2011). This approach is foundational to systemic family and couples therapies, which have been shown to be both effective and acceptable to clients across a variety of presenting issues. Additionally, therapeutic goals often include enhancing communication, resolving conflicts, and establishing healthier boundaries among family members, reflecting the need for a unified approach to couple functioning (George M Simon). By focusing on these principles, therapists strive to create a supportive environment that promotes understanding and collaboration, ultimately leading to sustainable changes in interpersonal dynamics. As such, the core principles of marriage and family therapy serve not only as a framework for intervention but also as a blueprint for achieving lasting relational growth.

Techniques used to address family dynamics

Learning about family patterns is key in marriage and family therapy (MFT). Experts use many techniques to fix relationship problems within the family group. These methods rely on the application of family systems theory. This theory says that the family environment mostly influences a person’s behavior. Therapists use different tools to help people talk and understand each other. They work to change broken patterns and make relationships better. Families use tools like genograms to see their history and relationship styles. This helps them see hidden problems under the surface. Interventions that help people share feelings can reduce fights and improve how families get along. Adding financial therapy helps the process by looking at money problems. These issues often make family stress worse for everyone involved. This work shows how money choices and family talk connect in complex ways. New reports show that many types of therapy help families stay healthy. They show that therapists must change their methods for each unique family situation. So, by mixing different methods, MFT creates paths for families to heal and understand each other.(Kristy A et al., 2018). Recent literature reviews highlight the effectiveness of diverse therapy modalities in fostering healthier family relations, demonstrating the necessity for adaptable approaches tailored to each unique family context (Evans P et al., 2012). Thus, by blending various techniques, MFT can create transformative pathways toward healing and understanding within families.

Common issues treated with structural therapy

Structural therapy addresses many common problems in marriage and family therapy. These concerns affect how families and couples relate. This method focuses on family interactions and hierarchies. It aims to fix broken patterns. These patterns stop people from talking well or feeling close. Treatment often covers topics like parent fights, boundaries between generations, and rivalry among siblings. Structural couple therapy (SCT) focuses on how partners interact. It sees how personal roles and boundaries can lead to pain or distance. SCT uses ideas from family therapy to help couples work through internal differences. It strengthens their bond and helps the relationship work better for both people. Research shows systemic family and couples therapy (SFCT) works well for many relationship concerns. Studies confirm it is a good and affordable choice for treatment. Structural therapy gives people good ways to face and fix problems in families or couples. It helps build healthier relationships.(George M Simon). Moreover, research highlights the significant effectiveness of systemic family and couples therapy (SFCT) in addressing a broad spectrum of relational issues, confirming its utility as both an acceptable and cost-effective therapeutic option (Stratton P, 2011). Ultimately, structural therapy offers valuable strategies for confronting and resolving issues within familial and couple contexts, thereby promoting healthier relationships.

Strategic Family Therapy

Marriage and Family Therapies help keep families healthy

Strategic Family Therapy (SFT) is a well-known method in marriage and family therapy. It focuses on how people interact with each other to create positive change. This model finds and fixes poor communication and behavior patterns. These patterns often cause many family problems. SFT looks at how the family interacts in the present. It does not look deep into the past or into old historical issues. This helps families find good ways to resolve their conflicts. Research shows that SFT works well. Long reviews show it works for many different clinical problems. Recent studies back these findings up. They show that family and couples therapy gets good results. These methods are cheap and easy for clients to use today (, ). These traits make SFT useful for modern practice. It is a helpful tool for therapists to use with families.(Evans P et al., 2012), (Stratton P, 2011)). Such attributes underscore the relevance of SFT in contemporary therapeutic practices, making it a valuable tool for clinicians.

Focus on problem-solving and behavior change

Marriage and family therapy focuses on solving problems and changing behavior. This focus helps create successful treatments for people and families. Therapists use a family systems method to understand relationships and how people act. They know that change in one part of a family affects all the other parts of that family. This view is helpful. It lets therapists find and treat many problems. These issues include relationship struggles and mood disorders. The process helps people interact in better ways. Therapists apply certain methods to start key talks. These talks aim to change old habits and views that stop growth. Research on these methods proves they work well. The data shows success in treating many mental and social hurdles. These include anxiety and the struggle to live with physical illness over many years. Combining problem-solving steps in therapy helps change behavior quickly. It builds healthy relationships for the long-term future of those family members.(Kristy A et al., 2018)(Carr A, 2018). Ultimately, the integration of problem-solving strategies within therapy not only facilitates immediate behavior change but also promotes long-term relational well-being

Role of therapist directives and interventions

Therapist directives and interventions play a key part in marriage and family therapy. They guide the process toward positive results. These actions vary from communication training to behavioral tasks. The choice depends on the theory of the therapist. For example, cognitive-behavioral methods use direct plans to challenge unhelpful thoughts. Systemic therapy focuses on how family members relate and uses quiet guidance. Studies show these methods work well. They report clear gains in how families get along after using structured therapist directives. A recent review explains why experts must change their methods to fit the exact needs of each family. This applies to families from many backgrounds. The review looked at studies from Australia and other countries. It shows that the best treatments combine proven methods with cultural changes. These results showcase the wide spectrum and efficacy of therapist directives to improve family therapy outcomes.(Evans P et al., 2012)(Evans P et al., 2012).

Typical scenarios where strategic therapy is effective

Strategic therapy works very well in many common situations found in marriage and family dynamics. For instance, families with communication problems benefit very much from treatments that reframe how they talk to each other. Therapists look at relationship patterns to find behaviors that do not work well. They use methods to create better communication habits among all family members. Strategic therapy helps during major life changes. These changes include things like divorce or joining two families together. Such events challenge the habits that families built over long periods. This method helps with the concerns of one person. It looks at the systemic factors behind relationship issues. Research shows that these therapies work well for people. Clients find them acceptable. They do not cost much for many different conditions. This proof makes strategic methods important in therapy today. It shows why these tools are useful in modern therapeutic practices.(Kristy A et al., 2018)(Stratton P, 2011).

Bowenian Family Therapy

Conflict resolution and understanding different family roles is key to helping families stay healthy.

Murray Bowen developed Bowenian Family Therapy. It looks at complex family patterns and the ways mental health issues pass through generations. Other therapy styles look mostly at individual change. Bowenian therapy works to improve the ways family members relate to each other. This method helps people separate their own emotional responses from the feelings of their relatives. It builds personal independence and makes family bonds stronger. Many studies show this therapy works well. It helps with anxiety, depression, and fights between relatives or partners. Reviews of systemic family and couples therapy (SFCT) show that clients like these methods. These reviews state it works for many mental health conditions (, ). This systemic view helps therapists look at how family history shapes the present. They guide clients to interact in better ways. This creates a lasting change in family dynamics.(Evans P et al., 2012), (Stratton P, 2011)). This systemic perspective allows therapists to explore past family influences while guiding clients towards healthier interactions, thereby establishing a lasting impact on family dynamics.

Emphasis on family systems and multigenerational patterns

Modern marriage and family therapy focuses on family systems and patterns across many generations. This focus helps people understand how relatives act together. The method shows that a person’s behavior does not come only from their own life. It comes from the history and roles within the whole family too. Experts use systemic family and couples therapy (SFCT) to find and fix these deep links. They show how family troubles move from one generation to the next. Studies show that SFCT works well for many different health issues. Clients like the treatment and feel glad they used it. This makes the method a useful part of medical practice. We can see how family therapy changed over many years. This history shows that family systems theory is a key part of mental health care now. Seeing and fixing how relatives affect each other brings big changes to the home. This work makes therapy more successful for families.(Stratton P, 2011). Furthermore, examining the evolution of family therapy underscores the lasting impact of family systems theory, positioning it as crucial for mental health services today (James L Framo, 1996). Ultimately, acknowledging and addressing multigenerational influences can lead to transformative changes in family dynamics, enhancing the effectiveness of therapeutic interventions.

  1. Key concepts such as differentiation of self

In marriage and family therapy, the idea of differentiation of self is key for building healthy relationships. Differentiation is the way a person keeps their sense of self. They do this by managing their feelings and connections with others. This idea comes from family systems theory. The theory links family patterns to a person’s actions. Therapists use methods to help clients grow their differentiation of self. They help clients see the effect of family beliefs and culture on their identities (). For example, Structural Couple Therapy (SCT) looks at couple interactions. It focuses on differences within subsystems and their effect on the whole system (). By building a stronger differentiation of self, therapists help clients talk better. They help them connect with feelings. This leads to better ways to solve fights and more happiness in the relationship.(Kristy A et al., 2018)). For example, Structural Couple Therapy (SCT) addresses the intricacies of couple dynamics, focusing on internal differences within subsystems and how these affect overall functioning ((George M Simon)). By enhancing differentiation of self, therapists can facilitate healthier communication patterns and emotional connections, ultimately leading to more effective conflict resolution and relational satisfaction.

Application in long-term family issues and emotional fusion

Long-term family issues often start with emotional fusion. Individual identities become too tied together. This leads to unhealthy patterns of interaction. Systemic family therapy (SFT) is a strong way to solve these issues. It builds better relationships and creates stronger emotional boundaries between family members. SFT shows conflict, anxiety, and chronic illness keep people emotionally stuck together. These problems stop personal growth and family unity. Research shows systemic methods lower the stress from these long-term problems. This confirms they work in many family situations. Meta-analyses and controlled trials show great success using family therapy for relationship stress and mental health problems. These studies support the claim SFT provides special tools. These tools differ from traditional therapies that focus only on individual change. The broad success of SFT treats relationship issues and helps people feel independent. It creates clearer communication. These changes lead to better family life and well-being over time.(Carr A, 2018). Furthermore, the broad effectiveness of SFT not only addresses relational issues but also fosters a sense of autonomy and clearer communication, translating into improved family functioning and well-being over time (Stratton P, 2011).

Conclusion

Please also review AIHCP’s Healthcare Certifications

Examining different types of marriage and family therapy shows that professionals must adapt their methods to fit each family. Current research highlights how well these methods work. A growing body of writing examines how they apply in different settings. Recent studies show that specific therapeutic techniques offer different advantages based on the problems a family faces. These techniques include cognitive-behavioral therapy, narrative therapy, and systemic therapy. Comparing Australian and international studies shows that successful practices are similar. This fact indicates that the main rules of therapy apply everywhere. Cultural differences exist, but the core principles remain relevant. The field of therapy continues to grow. Experts will keep checking results to improve their methods and make them work better. This process helps families get the right support for their specific needs. These steps keep marriage and family therapy an active and important part of mental health care.(Evans P et al., 2012). As the field continues to grow, ongoing evaluation of therapeutic outcomes will serve to refine methods and enhance their effectiveness, ensuring that families receive the most appropriate support for their needs (Evans P et al., 2012). In this way, marriage and family therapy remains a dynamic and vital component of mental health care.

Please also review AIHCP’s Behavioral Health Certifications

Summary of major therapy types and their unique contributions

Researchers look at many types of marriage and family therapy. People should note the unique ways these methods help the field. Each method uses a different framework to fix complex relationship problems. These methods help family members talk better and feel closer to one another. Systemic family and couples therapy (SFCT) looks at interactions between people. It does not just look at one person at a time. This tool helps people seeking to change their relationships. Research shows SFCT works for many health conditions. Studies show good results for people in this therapy. Many books and papers show different ways therapy works. Cognitive-behavioral therapy helps people change bad ways of thinking. Narrative therapy helps clients write new stories for their lives. Bringing these therapies together creates good plans for treatment to help couples and families succeed. These plans meet the many needs of families and couples today.(Stratton P, 2011). Additionally, the growing body of literature demonstrates the versatility of different therapy approaches, such as cognitive-behavioral therapy, which emphasizes altering maladaptive thought patterns, or narrative therapy, which empowers clients to reconstruct their personal narratives. Ultimately, the synthesis of these therapies yields comprehensive strategies that address the multifaceted needs of families and couples (Evans P et al., 2012).

Importance of selecting appropriate therapy for specific family needs

Marriage and family therapy success depends on choosing methods for each family’s unique needs. Families have different patterns, struggles, and histories. Therapists must understand these details to provide help that works for everyone. Research shows that therapy types must match each family situation and background. One review summarized different therapy types and their effectiveness through strict methods. Systemic family and couples therapy, or SFCT, adapts well to many family shapes and problems. This method provides a helpful resource that differs from therapies focused on one person. This resource works differently than traditional therapies that focus on individuals. Studies confirm this method works and that clients like the results it brings. The flexible nature of SFCT helps solve a wide range of family challenges and issues. Selecting the right therapy helps family systems reach positive outcomes over time.(Evans P et al., 2012). Systemic family and couples therapy (SFCT), in particular, has demonstrated a notable capacity to adapt to diverse family structures and issues, providing a valuable resource that differs markedly from traditional individual-focused therapies. Empirical studies confirm its efficacy and client acceptability, suggesting that the flexibility of SFCT offers significant advantages for addressing a wide array of familial challenges (Stratton P, 2011). Thus, the careful selection of therapy is indispensable for fostering positive outcomes in family systems.

Future directions in marriage and family therapy research and practice

Marriage and Family Therapy

The field of marriage and family therapy (MFT) changes every single day. Future work must use new research methods and inclusive ways to help different family structures. Professionals add technology like teletherapy and digital tools to help more people get help. These tools make therapy easier to reach for marginalized populations who often face barriers. Evidence-based practice advocated in promotes the careful study of different therapy types. This study improves current methods and creates new ones for therapists to use. Systemic family and couples therapy (SFCT) provides many paths for future study, as reported in . This model works for many different health conditions and helps many people in various settings. More study on how it works will show new ways to help clients improve. MFT builds better habits by focusing on inclusion and hard facts. This focus helps meet the complex needs of families today. It keeps therapy relevant and effective as the wider society changes over time.(Evans P et al., 2012) encourages the rigorous evaluation of various therapeutic modalities, refining existing approaches and cultivating new strategies. Systemic family and couples therapy (SFCT) is one model that offers promising avenues for future exploration, as reported in (Stratton P, 2011). Its adaptability to a range of conditions highlights its potential for broad application, suggesting that further investigation of its mechanisms may reveal additional insights into improving client outcomes. By prioritizing both inclusivity and empirical validation, MFT can progress toward more effective practices that meet the complex needs of contemporary families, thereby ensuring the relevance and efficacy of therapeutic interventions in a changing societal landscape.

Please also review AIHCP’s Healthcare Certifications

Additional AIHCP Blogs

Narrative Therapy and Grief: Access here

Additional Resources

Cherry, K. (2024). “What Is a Marriage and Family Therapist?”.  VeryWellMind.  Access here

“Marriage and Family Therapy”. Psychology Today.  Access here

Seay, N. (2025). “Marriage and Family Therapy”. MentalHealth.com. Access here

 

 

 

Hospital Consumables and Clinical Outcomes: What Procurement Choices Mean at the Bedside

Posted on by Joseph Gerard

Doctors wearing gloves giving a thumbs upWritten by Kelton Lewis & editorial team at MAP Medical,

Gloves, IV bags, and administration sets sit in every supply room, but their specifications shape infection rates, medication errors, and nurse workload in ways that purchase orders rarely reflect. Barrier failures, incompatible tubing, and inconsistent sizing show up first at the bedside, not in procurement dashboards. Facilities that source wholesale hospital supplies from distributors with documented quality controls give clinical teams something most contracting conversations overlook: consistency from one lot to the next.

Supply variation is not neutral. When a unit’s glove brand changes mid-week, nurses relearn tactile feedback, donning friction shifts, and occupational allergen profiles can move. When IV sets change manufacturers, Y-site port spacing, roller-clamp resistance, and drop factors may differ in ways that raise the cognitive load of high-acuity care. These small mismatches accumulate, which is precisely why value analysis committees staffed by clinicians, rather than contracting staff alone, should drive catalog decisions.

Gloves are the highest-volume consumable in any healthcare facility and a useful case study for these decisions. When a nurse or infection preventionist evaluates medical supplies gloves for formulary inclusion, four characteristics matter more than unit price: barrier integrity under use conditions, allergen profile, chemical resistance for expected tasks, and donning ergonomics. The regulatory baseline for these products is also specific enough to shape contract language.

The regulatory floor for medical gloves

Medical gloves function as primary barriers under OSHA’s Bloodborne Pathogens Standard, 29 CFR 1910.1030, which requires employers to provide appropriate PPE wherever occupational exposure to blood or other potentially infectious materials is reasonably anticipated (Occupational Safety and Health Administration, 1991). Every medical glove sold in the United States is a Class I reserved medical device that requires 510(k) premarket notification. Under 21 CFR 800.20, the Food and Drug Administration applies a minimum acceptable quality level (AQL) of 1.5 to surgical gloves and 2.5 to patient examination gloves, using the ISO 2859 sampling plan and a water-leak test method (U.S. Food and Drug Administration, 2024). A 2.5 AQL means that, statistically, up to 2.5 percent of gloves in a batch may contain pinhole defects and still pass inspection. Many health systems now specify 1.5 or lower for all exam gloves, particularly in oncology, emergency, and critical care units, where barrier reliability is non-negotiable.

Since January 18, 2017, powdered surgeon’s gloves, powdered patient examination gloves, and absorbable powder for lubricating a surgeon’s glove have been banned under the FDA’s final rule published at 81 FR 91722. The agency found these products to present an unreasonable and substantial risk of severe airway inflammation, hypersensitivity, and peritoneal adhesions, and determined that labeling changes could not mitigate these risks (U.S. Food and Drug Administration, 2016). Procurement specifications should still explicitly require powder-free product, because the ban does not apply to powdered radiographic protection gloves, and cross-border sourcing of non-compliant stock remains a risk.

Material selection in practice

Nitrile

Nitrile has become the clinical default for non-surgical use across most U.S. health systems. It is latex-free, has strong puncture resistance, and performs reliably against common disinfectants. For oncology and pharmacy personnel handling antineoplastic agents, United States Pharmacopeia General Chapter 800 requires gloves tested under ASTM D6978 for chemotherapy drug permeation, along with double-gloving during compounding and administration (United States Pharmacopeial Convention, 2019). Facilities should stock these chemotherapy-rated gloves as a separate line item from standard exam inventory, and pair them with compliant gowns and engineering controls.

Latex

Natural rubber latex still offers the most refined tactile feedback, which is why many surgeons continue to prefer it for procedures that require fine motor control. Its drawback is well documented: occupational IgE-mediated sensitization in healthcare workers, with reported worldwide prevalence averaging around 9.7 percent and rising higher in populations with intense latex exposure prior to the shift toward powder-free and synthetic alternatives (Wu et al., 2016). Facilities that stock latex for surgery should maintain synthetic alternatives for latex-sensitive staff and patients, and a latex-safe protocol for known allergies.

Vinyl

Vinyl gloves are suitable for brief, low-risk tasks such as environmental services, food handling, and certain non-sterile support functions. They are a poor choice for sustained patient contact, venipuncture, or any scenario where barrier integrity must hold under stretch.

IV administration sets and medication safety

Infusion-related errors remain among the most frequent preventable harms in acute care. The 2024 INS Infusion Therapy Standards of Practice, now in its ninth edition and published as a supplement to the Journal of Infusion Nursing, establishes evidence-based expectations for device selection, care, and evaluation across the infusion pathway (Nickel et al., 2024). Several design elements deserve specific attention during procurement.

Free-flow protection

An administration set without integrated anti-free-flow protection can deliver an uncontrolled gravity bolus when tubing is removed from a pump. Free-flow protection should be a baseline specification for any set used with electronic infusion devices, and the clinical team should confirm that the mechanism engages automatically, rather than requiring a separate step by staff.

DEHP-plasticized tubing

Di(2-ethylhexyl) phthalate is a plasticizer historically used in PVC tubing. It can leach from tubing into infusates, with leaching rates highest in lipid-containing solutions. In its 2002 public health notification, the FDA identified male neonates, pregnant women carrying male fetuses, and peripubertal males as populations of concern, particularly during total parenteral nutrition, ECMO, and multi-device procedures in the NICU (U.S. Food and Drug Administration, 2002). DEHP-free tubing is now standard in NICU, PICU, and oncology settings in most U.S. health systems, and should be specified explicitly in purchase contracts for those units.

Drop-factor standardization

Macro-drip sets (typically 10, 15, or 20 gtt/mL) and micro-drip sets (60 gtt/mL) serve different clinical purposes. Mixing drop factors on a single unit invites calculation errors when staff revert to manual rate verification during pump downtime. Facility-wide standardization, supported by written policy and clear labeling, reduces this risk.

Supply chain resilience after 2020

The COVID-19 pandemic exposed the fragility of single-source consumable procurement. Glove shortages, IV fluid allocations, and PPE rationing forced many U.S. hospitals to rebuild sourcing strategies. Dual-source agreements, real-time PAR-level dashboards, and formal substitutability testing for backup SKUs have become the new baseline. Nurses, who see empty bins before they appear in a report, are the most reliable early signal in this process and should be invited into sourcing reviews rather than informed of their outcomes.

The clinical voice in value analysis

Clinical staff surface evidence that contract bids cannot: tear rates on 12-hour shifts, skin reactions that emerge over weeks, tubing kinks in crowded corridors, pump alarms that correlate with a specific set design. Formalizing nurse participation on value analysis committees consistently produces better formulary decisions and stronger staff engagement with supply protocols. The financial case is also direct: a product that reduces one medication error or one catheter-related bloodstream infection pays for significant price differences many times over.

Choosing a wholesale partner

A supplier’s role is not limited to fulfillment. Clinical teams benefit from partners that can produce FDA 510(k) documentation, ASTM test reports, and lot-level quality data on request. MAP Medical is a distributor of medical products for clinics, hospitals, and surgical centers, carrying gloves, IV bags, IV sets, and other daily consumables supplied under the quality standards outlined here.

About the authors

This article was prepared by the editorial team at MAP Medical, a U.S. distributor of medical consumables to clinics, hospitals, and surgical centers, together with Kelton Lewis, Managing Manager. The team draws on direct experience supporting procurement, infection prevention, and nursing leadership across acute-care facilities.

References

Nickel, B., Gorski, L., Kleidon, T., Kyes, A., DeVries, M., Keogh, S., Meyer, B., Sarver, M. J., Crickman, R., Ong, J., Clare, S., & Hagle, M. E. (2024). Infusion therapy standards of practice (9th ed.). Journal of Infusion Nursing, 47(1S Suppl. 1), S1-S285. https://doi.org/10.1097/NAN.0000000000000532

Occupational Safety and Health Administration. (1991). Bloodborne pathogens standard, 29 CFR 1910.1030. U.S. Department of Labor.

United States Pharmacopeial Convention. (2019). USP general chapter <800>: Hazardous drugs-handling in healthcare settings. USP Compounding Compendium.

U.S. Food and Drug Administration. (2002). Public health notification: PVC devices containing the plasticizer DEHP. Center for Devices and Radiological Health.

U.S. Food and Drug Administration. (2016). Banned devices: powdered surgeon’s gloves, powdered patient examination gloves, and absorbable powder for lubricating a surgeon’s glove. Federal Register, 81(243), 91722-91731.

U.S. Food and Drug Administration. (2024). Patient examination gloves and surgeons’ gloves; sample plans and test method for leakage defects; adulteration, 21 CFR 800.20. Code of Federal Regulations.

Wu, M., McIntosh, J., & Liu, J. (2016). Current prevalence rate of latex allergy: Why it remains a problem? Journal of Occupational Health, 58(2), 138-144. https://doi.org/10.1539/joh.15-0275-RA

 

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Workplace Violence Prevention in Healthcare: Bridging Clinical Training and Security

Posted on by Joseph Gerard

Vector imagine of doctors and nurses togetherWritten by Harry Wolf

According to the U.S. Government Accountability Office, it is estimated that those wonderful people who work in healthcare facilities sadly experience substantially higher rates of workplace violence – compared to workers in other sectors, that is. So, prevention strategies matter!

Workplace Violence 

Workplace violence… It extends far beyond physical altercations. It includes any act or threat of physical violence, harassment, intimidation, or disruptive behavior from patients, family members, visitors, students, colleagues, or outside individuals. 

Verbal abuse, psychological intimidation, sexual misconduct, and physical assault – they all fall within its scope.

Nurses and frontline clinicians face heightened exposure. Why is that? Because of their close proximity to patients. 

A 2021 Press Ganey survey, highlighted by the American Nurses Association, found that – staggeringly – two nurses per hour are assaulted in acute care settings. Such frequency underscores just how routine aggression can become in high-acuity environments.

Violence also exists on a continuum. Incivility refers to low-intensity, disrespectful behaviors that violate norms of mutual respect. And bullying involves repeated, intentional hostility. Both can erode psychological safety and contribute to distress.

Aggression… It may originate from distressed patients or family members. But internal hostility between colleagues is also documented across healthcare settings. 

Clear definitions matter. Why is that? Quite simply, because underreporting remains common. 

When verbal threats or intimidation are normalized as part of clinical work, patterns remain hidden.

Now, let’s explore how to prevent workplace violence in the healthcare sector.

Conduct a Data-Driven Risk Assessment 

Prevention in healthcare begins with rigorous risk identification. Organizations cannot manage what they do not measure, after all. 

And anecdotal impressions… Well, they often underestimate patterns of escalation.

If it goes unaddressed, workplace violence can create:

  • High employee turnover
  • Recruitment challenges
  • Reputational risk for the healthcare facilities

A comprehensive risk assessment should include:

  • Reviewing historical incidents and near-miss reports 
  • Mapping high-risk locations 
  • Evaluating staffing ratios and wait-time pressures during peak operational hours

Expand Data Sources Beyond Incident Reports

Incident reporting systems… Unfortunately, they capture only a portion of actual events. Yes, underreporting remains common, particularly when staff perceive aggression as part of the job (which they really shouldn’t have to do!).

Leaders should incorporate workers’ compensation data, security logs, patient complaint records, and even exit interview feedback. Patterns often emerge when data sources are cross-referenced.

Align Assessment With Regulatory Guidance

National frameworks offer structure for local programs. The Occupational Safety and Health Administration outlines core elements of an effective workplace violence prevention program, which includes:

  • Management commitment
  • Employee participation
  • Hazard identification
  • Ongoing evaluation

Alignment with federal guidance strengthens compliance posture and supports accreditation readiness. Documented risk assessments also help justify capital investments in staffing, training, and physical infrastructure.

Strengthen De-Escalation and Provide Training

Training serves as a frontline defense against escalation. However, meaningful prevention requires interactive, skill-based education – rather than passive online modules, that is.

The National Institute for Occupational Safety and Health emphasizes that effective prevention combines administrative controls with targeted worker training. For clinicians, preparation influences not only safety outcomes but also therapeutic rapport.

Comprehensive training programs typically include:

  • Simulation-based role play 
  • Education on trauma-informed communication techniques
  • Clear guidance on when and how to activate security or emergency response systems

Standardize Escalation Protocols Across Departments

De-escalation techniques… They must align with clear escalation pathways. Code terminology, alarm activation procedures, and response hierarchies should all remain consistent across departments – to reduce confusion, that is.

Interdisciplinary drills reinforce readiness. Practicing realistic scenarios involving aggressive visitors, psychiatric emergencies, or intoxicated patients improves response coordination – and reduces hesitation, as well.

Implement Controlled Access and Layered Physical Security

Clinical skill mitigates risk but cannot eliminate all threats. Healthcare facilities remain open and dynamic environments. In turn, that unfortunately increases exposure to unpredictable behavior.

Physical security infrastructure… It functions both as a deterrent and a response support. Effective physical security measures often include:

  • Badge-based access control limiting entry to restricted clinical areas
  • Visitor management systems with identity verification and time tracking
  • Clearly identifiable security presence in high-risk departments

Design Environments That Support Safety

Environmental design influences behavior. For instance? Open sightlines reduce concealment opportunities, and secure nursing stations limit direct access to staff.

Also, furniture placement can prevent entrapment and ensure unobstructed exit routes. And exam rooms and triage spaces should allow clinicians to position themselves closer to exits when feasible.

Lighting, signage, and controlled entry points… They all further contribute to perceived and actual safety. Balanced design maintains patient-centered accessibility while reinforcing boundaries.

Partner With Experienced Security Firms

Healthcare organizations frequently collaborate with a trusted security system installer to implement integrated access control, surveillance, and alarm systems. Professional system integration reduces compatibility issues – and enhances reliability, too. 

Layered security measures, when thoughtfully implemented, reinforce clinical efforts –  and that’s without creating a punitive or intimidating environment.

Deploy Real-Time Monitoring and Communication Systems

Video surveillance systems, duress alarms, and centralized monitoring centers… They all enable security personnel to assess unfolding events quickly. And integration with mobile devices ensures that supervisors and administrators remain informed.

Core monitoring components? They frequently include:

  • Discreet panic buttons
  • Centralized video management systems with live-feed capabilities
  • Two-way communication platforms connecting clinical staff and security teams

Integrate Technology Into Clinical Workflow

Technology must remain intuitive and unobtrusive. Alarm systems should be easily accessible yet discreet – to avoid escalating patient agitation, that is.

Clear response expectations reduce uncertainty. Staff members should understand who responds to alerts, anticipated response times, and post-incident documentation requirements.

Leverage Data 

Monitoring systems generate valuable data. Video recordings and alarm logs allow leadership teams to conduct structured root cause analyses – after incidents occur, that is.

Foster a Culture of Reporting 

Organizational culture ultimately determines whether workplace violence prevention efforts succeed. Underreporting undermines risk assessment – and leaves systemic vulnerabilities unaddressed, too.

And for individual clinicians, repeated exposure to workplace violence without institutional support increases burnout risk and may contribute to workforce attrition.

A strong safety culture includes:

  • Anonymous reporting channels
  • Access to counseling, peer-support networks, and post-incident debriefings

Address Psychological Impact 

Exposure to aggression… It can produce anxiety, sleep disturbance, and moral injury. Early psychological support mitigates long-term effects.

Structured debriefings following significant incidents provide emotional processing space. And they encourage feedback on system improvement. 

Establish Measurable Benchmarks

Continuous improvement… It requires measurable goals. Organizations may track:

  • Incident frequency
  • Injury severity
  • Response times

Long-term success depends on:

  • Leadership commitment
  • Adequate funding
  • Ongoing education

So, prevention programs should evolve in response to: demographic shifts, emerging threats, and technological advancements.

Strengthen Policy Infrastructure 

Workplace violence prevention in healthcare cannot rely solely on frontline efforts. Clear policy infrastructure and defined governance structures ensure consistency – across departments, campuses, and affiliated outpatient sites, that is.

Formal governance signals that prevention is an organizational priority rather than a unit-level initiative. When executive leadership, clinical directors, human resources, legal counsel, and security leaders collaborate, policies become more enforceable and sustainable.

Core governance elements? Well, they often include:

  • A multidisciplinary workplace violence prevention committee
  • Written zero-tolerance policies 
  • Standardized documentation and investigation procedures

Clarify Behavioral Definitions and Consequences

Ambiguity… It weakens enforcement. Policies should define (in explicit terms):

  • Verbal threats
  • Intimidation
  • Harassment
  • Physical assault

Progressive response pathways must also be documented. Consequences for visitors, patients, contractors, or staff should align with legal requirements and ethical obligations.

Clear behavioral agreements for high-risk patients may also reduce escalation. In some cases, care plans include behavioral expectations – which are developed collaboratively with the patient and care team.

Integrate Legal and Regulatory Considerations

Of course, healthcare facilities operate within a complex regulatory environment. State laws governing assault on healthcare workers, mandatory reporting requirements, and patient rights statutes must be reflected in policy language.

Legal counsel should review reporting protocols and ensure alignment with:

  • Labor law
  • Privacy standards
  • Accreditation expectations. 

Documentation processes must support potential litigation or regulatory review.

Regular policy audits help identify outdated procedures or inconsistent application – across departments, that is. Governance structures that meet quarterly and review aggregate data promote accountability at the highest level.

Design Workforce Support and Resilience Programs

Preventing workplace violence in healthcare also requires strengthening workforce resilience. Staff who feel supported and psychologically prepared are better equipped to manage volatile encounters.

Violence prevention efforts should, therefore, extend beyond physical safety measures and into professional well-being initiatives. Resilience-building programs reinforce coping strategies and reduce cumulative stress.

Effective workforce support strategies? Well, they may include:

  • Structured resilience training integrated into professional development programs
  • Peer-mentor systems for new clinicians entering high-risk specialties
  • Scheduled wellness check-ins following critical incidents

Address Fatigue and Staffing Pressures

Operational stressors such as long shifts, mandatory overtime, and high patient acuity… They can all potentially amplify vulnerability to violence. And the thing is: fatigue impairs situational awareness and reaction time.

Leaders should evaluate:

  • Scheduling practices
  • Staffing ratios
  • Float pool availability

Strategic staffing adjustments during historically high-risk shifts may prevent escalation before it begins.

Incorporate Prevention Into Academic and Residency Training

Academic medical centers and teaching hospitals play a crucial role in shaping professional norms. Curricula should integrate:

  • Prevention principles
  • Reporting expectations
  • Communication skills training

Early normalization of reporting reduces long-term underreporting trends.

Simulation laboratories can replicate high-risk scenarios in controlled environments. Exposure to structured practice increases confidence and preparedness before trainees encounter real-world volatility.

Workforce resilience initiatives complement physical security and policy infrastructure. Together, they reinforce a comprehensive, prevention-oriented culture.

Advancing Workplace Violence Prevention 

Workplace violence prevention in healthcare. As we have seen, it demands coordinated action across clinical practice, education, security operations, and executive leadership. 

Healthcare organizations that invest in integrated security infrastructure and interdisciplinary collaboration will strengthen both staff well-being and patient care quality.

Was this article helpful? If so, be sure to take a look at our other insightful content. 

 

Author bio: Harry Wolf is a freelance writer. For almost a decade, he has written on topics ranging from healthcare to business leadership for multiple high-profile websites and online magazines.

References:

  • Unauthored, 2016, Workplace Safety and Health: Additional Efforts Needed to Help Protect Health Care Workers from Workplace Violence, U.S. Government Accountability Office.

https://www.gao.gov/products/gao-16-11

 

  • Unauthored, 2021, Workplace Violence: Protect Yourselves, Protect Your Patients, American Nurses Association.

https://www.nursingworld.org/practice-policy/work-environment/wpv/

  • Unauthored, 2016, Workplace Violence, Occupational Safety and Health Administration.

https://www.osha.gov/healthcare/workplace-violence

  • Unauthored, 2024, Violence and Work, Centers for Disease Control and Prevention.

https://www.cdc.gov/niosh/violence/about/?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fniosh%2Ftopics%2Fviolence%2Fdefault.html

  • Behrens, M., Gube, M., Chaabene, H., Prieske, O., Zenon, A., Broscheid, K.-C., Schega, L., Husmann, F., & Weippert, M., 2022, Fatigue and Human Performance: An Updated Framework, National Library of Medicine.

https://pmc.ncbi.nlm.nih.gov/articles/PMC9807493/

 

 

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Behavioral Health and the Dark Triad

Posted on by Mark Moran

Researchers have studied the Dark Triad of psychopathology since 2002. This group includes psychopathy, narcissism, and Machiavellianism. The topic has gained much notice in academic circles and public talks. Many peer-reviewed articles show this growth. These papers explain and examine the complex parts of these linked personality traits. Early research showed how these traits overlap. A shared core of cold manipulation defines them. Scholars now see that each trait has many sides. This view challenges older ideas that viewed each trait to be one unit. Studies on the Dark Triad now include talks about measurement differences and method concerns. These include using easy-to-reach samples and relying on single ways to collect data. We must fix these issues to help our understanding grow. Doing so will make future studies in this field of psychology stronger.(Joshua D Miller et al., 2019). While initial research underscored their conceptual overlap—characterized by a shared core of callous manipulation—scholars have increasingly recognized the multidimensionality of each trait, challenging earlier perspectives that treated them as unidimensional (Furnham A et al., 2013). Consequently, the landscape of Dark Triad research has evolved to include discussions on measurement discrepancies and methodological concerns, such as convenience sampling and the reliance on mono-method approaches. Addressing these issues is crucial for advancing our understanding and ensuring the robustness of future studies in this significant area of psychological inquiry.

Please also review AIHCP’s Behavioral Health Certifications.

Definition and Overview of the Dark Triad

The Dark Triad. Please also review AIHCP’s Healthcare Certifications

The Dark Triad includes Machiavellianism, narcissism, and subclinical psychopathy. These three traits form a group of harmful personality types that psychologists study often. These traits share a core of cold and manipulative behavior. This behavior often causes harmful results in social settings and interpersonal relationships. Recent studies show how these traits overlap and how they differ. They are key tools for understanding complex human actions in the study of mental illness. Researchers look at where these traits start and how they appear in people. This work shows how the traits lead to antisocial acts and damaged relationships. New studies on dark personality traits show why they matter to abnormal psychology. This base of knowledge calls for more study on how these traits affect mental health and how society works.(Furnham A et al., 2013). Furthermore, explorations into the origins and manifestations of these traits underscore their significance in the development of antisocial behaviors and dysfunctional interpersonal relationships, a point emphasized by emerging studies on dark personality traits and their relevance to abnormal psychology (Thomaes S et al., 2017). This foundation invites further inquiry into their implications for mental health and societal functioning.

Importance of Studying Psychopathological Traits

Psychologists must understand psychopathological traits for research and practical use in various fields like clinical psychology, criminology, and organizational behavior. The Dark Triad includes Machiavellianism, narcissism, and psychopathy. It helps explain harmful social behaviors like manipulation, self-interest, and a lack of empathy. Researchers study these traits to see how they link to poor social behaviors and relationships. Scientists created short tools like the Short Dark Triad (SD3). These tools help test people in both clinical and general groups (). More Dark Triad studies appear. Psychologists place these traits into larger psychological models to see the structure of personality and what it means ().(Daniel N Jones et al., 2013)). Additionally, as the literature surrounding the Dark Triad expands, it becomes increasingly relevant to place these traits within broader psychological frameworks, enhancing our understanding of personality structure and its implications ((Furnham A et al., 2013)).

As science progresses, there are clear ties within the brain’s ability to foster emotion, regret, or remorse attached to the amygdala.  Yet, one cannot simply justify such extreme and vile behaviors that fall under the category of anti-social disorders, simply because one does not feel.  One can understand how it may be easier to be cold and ruthless, but one still possesses the knowledge of right and wrong.  While secular science only studies the biological, many spiritual counselors believe there is more than just merely a physiological issue, but also a spiritual one.  Vice, habitual immorality, moral relative attitudes, and evil influences can also contribute to an individual who displays such disregard for other human beings.

The danger becomes when there is no balance in understanding these individuals.  If one looks for only empirical studies at neglect of spiritual, or if one dismisses the science for only spiritual answers, then the whole story will not be presented.  It is important to understand both elements.  So, counselor should be well versed in the scientific explanations and reasons why individuals do not feel or show empathy, but also beyond the biological, review the behavioral history, trauma, and other spiritual distresses that have allowed this malignant personality to fester.  There will be differing degrees of where one falls, but also different levels of how far someone will go in regards to hurting another person.

Characteristics and Behavioral Patterns

The Dark Triad of Psychopathology includes Machiavellianism, narcissism, and psychopathy, and these behavioral patterns show a shared tendency to both manipulate and exploit other people in their lives. People with these traits often show a liking for lies and a clear lack of empathy. They chase their own interests in both social and work situations at all times. Research grew a lot after the framework began, showing different connections and how these traits work together in various settings [citeX]. The creation of reliable tools like the Short Dark Triad (SD3) shows the urgent need to test these traits well and quickly in many groups [extractedKnowledgeX]. We learn more about how these traits affect interpersonal relationships and societal dynamics by understanding these characteristics.(Furnham A et al., 2013). The development of reliable measurement tools, such as the Short Dark Triad (SD3), underscores the urgent need to assess these attributes efficiently and effectively in diverse populations (Daniel N Jones et al., 2013). By understanding these characteristics, we gain insight into their broader implications for interpersonal relationships and societal dynamics

These individuals will be very self-centered, proud and vain.  They will exhibit charm and charisma for who they want but will ruthlessly remove (at varying levels) those who pose a threat to them.  They will manipulate and see individuals as pawns to their own needs.  In addition, some will be cold and calculating while others may be very emotional in outbursts.  This varies pending on if they are a psychopath or sociopath.  In addition, they hold to a strong subjective morality that values their belief system over others.  In addition, they may be extremely greedy, lustful, or possess other vices at high levels.

While many of these anti-social behaviors at the biological level, or exist due to past trauma and abuse, one cannot easily dismiss the lack of virtue in their lives.  At one point, one has to accept responsibility.  While it may be difficult, one cannot live a sinful and vice filled life and justify it due to the past or biological factors.  While these issues can contribute to their condition, these individuals still possess free will and can choose to better themselves.

While they are not as common, these individuals do exist.   Unfortunately, many times, individuals hurl these names onto people they are upset with.  A person can exhibit some traits, or vices in life and not be clinically diagnosed with any of the three personality disorders.  All human beings can be selfish, or use others at times, but individuals who truly are clinically narcissistic, or psychopathic, behave habitually not randomly.  They exhibit the behaviors universally and have zero ability to show remorse.  Some are clinically worst than others.  Some are far more dangerous than others in the lengths of their plans, but a person who truly exhibits these behaviors at a clinical level is unforgettable.

 

Psychological and Neurological Underpinnings

The psychological and neurological roots of the Dark Triad show how complex these antisocial traits are. The triad includes psychopathy, narcissism, and Machiavellianism. Research shows these traits share a harsh core of callous manipulation. This manipulation appears through clear behavior patterns and emotional reactions. For example, people with these traits often exploit others. They show a lack of empathy at the same time. This lack of empathy links to specific brain differences. One difference is lower activity in the amygdala during emotional processing. This lack of brain activity helps researchers understand the motives behind Dark Triad behaviors. Researchers look at how these traits work together using different models. New studies emphasize how these traits relate to broader mental health issues. Explaining these psychological and neurological models gives useful ideas about how these traits continue and spread. This work helps people understand abnormal psychology more clearly.(Thomaes S et al., 2017). Consequently, elucidating the psychological and neurological frameworks can provide significant insights into the maintenance and proliferation of these traits, contributing to a more comprehensive understanding of abnormal psychology (Furnham A et al., 2013).

Psychopathy

Psychopaths, as well as sociopaths have no remorse

Psychopathy is a major part of the Dark Triad of Psychopathology. It connects to narcissism and Machiavellianism but has unique features that set it apart. This personality trait shows a total lack of empathy and weak emotional reactions. It leads to a habit of manipulating others. Research finds psychopathy includes coldness and acting on whims. These traits put people at a higher risk for breaking social rules and acting against society. Recent meta-analytic findings show these dark traits are related. They are separate but have similar effects on behavior and personality structure. This is true for traits like agreeableness in the Big Five model. Experts put psychopathy in the interpersonal circumplex and Five- and Six-Factor models. This proves the trait has many parts and is hard to measure. Understanding psychopathy is needed to deal with its impact on society.(Muris P et al., 2017). Moreover, psychopathy has been situated within both the interpersonal circumplex and the Five- and Six-Factor models of personality, underscoring its multifaceted nature and the complexities of measuring its manifestations (Furnham A et al., 2013). Understanding psychopathy is essential for addressing its societal consequences effectively.

Sociopathy can also find itself within these conditions.  Sociopathy and Psychopathy are similar in that neither express remorse or feel emotion but sociopathy is more a learned behavior as opposed to psychopathy which is genetic.    Both represent issues within the brain to feel and express emotion, but there reactions also vary.  Sociopaths tend to be more impulsive or reactive and emotional, while psychopaths are more calculating and controlled.

 

Narcissism

Self love and Narcissism

Narcissism is one trait in the Dark Triad of Psychopathology, and it affects interpersonal relationships and self-perception in a unique way. Narcissists show grandiosity and need constant admiration, but they lack empathy and value their self-image above all else. This focus causes great trouble in personal connections and leads to callous, manipulative behavior. Narcissists share these traits with Machiavellianism and psychopathy. Research shows narcissists may exploit others in an endless quest for validation and power. Narcissism connects with other Dark Triad traits, so we must study its impact more. This matters most in offices and social groups. In these settings, interpersonal actions change the results.(Furnham A et al., 2013). Research indicates that narcissists may engage in exploitative behaviors, driven by their insatiable quest for validation and dominance (Daniel N Jones et al., 2013). Moreover, the interplay of narcissism with the other traits in the Dark Triad underscores the necessity for further examination of its implications, particularly in social and organizational contexts where interpersonal dynamics significantly influence outcomes.

Core Traits and Manifestations

Studies on the Dark Triad show that Machiavellianism, narcissism, and psychopathy appear in different but connected ways. These core traits affect how people act and how they talk to others in their daily lives. Every trait shares a common base of coldness and manipulation. Paulhus and Williams described these features in their early work on the triad. These traits lead to harmful behaviors. They also play a large role in mental health disorders. We must understand how these complex traits work. The way these traits work together leads to many bad results. These results include fights between people and damage to mental health. Researchers study these traits more today. We must see how they fit into general psychology. This work helps experts find new ways to treat people who show these three traits.(Furnham A et al., 2013). These socially aversive traits not only contribute to maladaptive behaviors but also play a significant role in psychopathology, underscoring the need for a nuanced understanding of their complexity (Thomaes S et al., 2017). The interplay of these traits can lead to various detrimental outcomes, including interpersonal conflicts and detrimental effects on mental health. As researchers continue to investigate these traits, it becomes increasingly important to appreciate their implications for broader psychological frameworks, thereby paving the way for innovative approaches in the treatment of individuals exhibiting these characteristics.

Impact on Interpersonal Relationships

Machiavellianism, narcissism, and psychopathy make up the Dark Triad traits. These traits disrupt relationships and cause many negative results for both the people who have them and others around them. Research shows people who score high in these traits often use manipulation and exploitation. This behavior lowers trust and creates conflict in the relationships they have. For example, the cold nature of these people pushes others away. Their interactions stay shallow and lack any real emotional connection. The creation of the Short Dark Triad (SD3) test helps experts study these patterns. This tool shows how these traits predict bad results, like more aggression and less teamwork. These dark traits affect more than just the actions of one person. They change how people interact with each other in their social lives.(Furnham A et al., 2013). Additionally, the development of instruments such as the Short Dark Triad (SD3) has facilitated the exploration of these dynamics, revealing how these traits can predict adverse relational outcomes, including increased aggression and decreased cooperation (Daniel N Jones et al., 2013). Ultimately, the repercussions of the Dark Triad extend beyond individual actions, deeply influencing the fabric of social interactions.

Machiavellianism

Using a person for one’s own gain

Machiavellianism is a main part of the Dark Triad. This personality type uses manipulation and deceit. These people use a harsh way of dealing with others. This trait has a similar base to psychopathy and narcissism. It stays different. It focuses on planning how to use people. It involves being cold and detached. New studies show that Machiavellianism often overlaps with narcissism and psychopathy. This highlights the shared trait of cruel manipulation. This trait defines the whole Dark Triad group. Experts sometimes ignore that these ideas have many layers. This makes it hard for researchers who want to study their links. Scientists can look at Machiavellianism as its own trait and as part of a bigger group. This helps them judge its impact on how people act and mental tests. This detailed view adds to the discussion. It helps people create better ways to help those with these traits.(Furnham A et al., 2013). However, the treatment of these constructs sometimes overlooks their multidimensional nature, presenting a significant challenge to researchers aiming to dissect their intricate relationships (Joshua D Miller et al., 2019). By understanding Machiavellianism as both a standalone personality trait and a part of a broader construct, researchers can better assess its implications for social behavior and psychological assessment. This nuanced perspective not only enriches the conversation but also aids in developing more effective intervention strategies for individuals exhibiting such traits.Manipulative Strategies and Traits

Manipulative tactics are part of Dark Triad behaviors. These behaviors include narcissism, Machiavellianism, and psychopathy. These traits share a core of callousness and a drive to control other people. This focus often leads to poor social and mental results. Studies find that people with these traits often use lies. They manipulate others to help themselves and do not care about the well-being of others. These traits overlap in complex ways, and that makes it hard to judge a person. For example, narcissists use others to protect their own self-esteem. Machiavellians use these tactics for their own benefit (). Other research links these traits to low levels of agreeableness. This shows a clear lack of care for getting along with others (). Learning about these tactics helps us understand the broad effects of the Dark Triad on social groups.(Bundy T et al., 2017)). Furthermore, research highlights that these traits are significantly correlated with lower levels of agreeableness, indicating a pronounced disregard for interpersonal harmony ((Furnham A et al., 2013)). Understanding these manipulative strategies enhances our comprehension of the broader implications of the Dark Triad on social dynamics.

Role in Social and Occupational Contexts

The Dark Triad of Psychopathology includes Machiavellianism, narcissism, and psychopathy, and these traits affect how people act in social and work settings. People with these traits often manipulate social situations to benefit themselves. They find short-term success but often damage long-term bonds and workplace peace. Research shows high levels of Machiavellianism and psychopathy cause job performance to drop. These traits break down team unity and lower output. The ways these people interact involve cold manipulation. This behavior ruins relationships and changes the office culture. Understanding these traits helps reduce their impact on the workplace and build better social habits.(Ernest H O’Boyle et al., 2011). Furthermore, the interpersonal strategies employed by those with Dark Triad characteristics reveal a common thread of callous manipulation that not only affects interpersonal relationships but also shapes workplace cultures (Furnham A et al., 2013). Consequently, understanding these traits is essential for mitigating their impact on organizational environments and fostering healthier social interactions.

Conclusion

The Dark Triad represents a very dangerous person at varying levels. Please also review AIHCP’s Healthcare Certifications

The Dark Triad of Psychopathology includes Machiavellianism, narcissism, and psychopathy. Studying these traits shows us people’s actions. We see how they treat each other. These three bad traits are different, but they all involve mean ways of using people. Psychologists must use precise tests to study them. Research, like the work by Paulhus and Williams, shows these traits. They share some features and link to their own mental results. Experts made fast tools like the Short Dark Triad (SD3) for researchers and doctors. These tools are precise. They help us see these traits in local groups and clinics. We can learn about bad behaviors and their effect on society by looking at the Dark Triad’s meaning.(Furnham A et al., 2013). Moreover, the development of efficient measures like the Short Dark Triad (SD3) underscores the importance of reliable assessment tools for researchers and practitioners alike, allowing for a comprehensive understanding of these traits in both community and clinical settings (Daniel N Jones et al., 2013). Ultimately, addressing the implications of the Dark Triad can enhance our grasp of maladaptive behaviors and their impact on society.

It is also crucial for individuals to understand the dangers and signs of meeting these types of individuals.  They can be quite charming at first but overtime, the fake mask is removed.

Please also review AIHCP’s Behavioral Health Certifications.

Summary of the Dark Triad’s Influence in Psychopathology

The Dark Triad includes narcissism, Machiavellianism, and psychopathy. These three traits help us understand the field of psychopathology. They relate to antisocial behaviors and problems with social connections. Research shows these traits link together and are common in men. They show a concerning link to negative social results like conflict and aggression. The shared core of callous manipulation among these traits reflects a pattern of bad behaviors. These behaviors challenge old ideas about personality. The findings show we need better ways to measure these traits. We must look past simple tests to see the full picture. We need a broad look at how they affect mental health. The effects of the Dark Triad appear in clinics and other psychology fields. These complex patterns require more study in future research projects.(Muris P et al., 2017). Moreover, the shared core of callous manipulation among these traits reflects a broader pattern of maladaptive behaviors that challenge traditional personality paradigms (Furnham A et al., 2013). These findings underscore the necessity for nuanced measurement approaches that capture the complexity of these traits, moving beyond simplistic assessments to embrace a more comprehensive analysis of their influence on psychological health. Ultimately, the implications of the Dark Triad’s dynamics extend into both clinical and applied psychological realms, warranting further scrutiny in future research.

Implications for Research and Mental Health Interventions

Researchers study the Dark Triad, and this group includes psychopathy, narcissism, and Machiavellianism. This work helps science and mental health care. The field of study has changed over the years. Treating these traits as one simple thing is a mistake that makes therapy less effective. Experts use proven psychological models to study these traits. This work helps us see them clearly. It leads to treatments for their cruel and tricky core parts. Researchers are now building better ways to measure these traits. These tools help them separate overlapping parts of each trait. This data helps doctors choose the right therapy for their patients. It makes treatments work better for people with Dark Triad traits, and this care leads to better results in mental health care.(Joshua D Miller et al., 2019). Moreover, examining these traits within the framework of established psychological models promises to refine our understanding, potentially leading to targeted interventions that address their callous-manipulative core (Furnham A et al., 2013). As researchers develop more comprehensive measurement tools and methodologies, the capacity to disentangle these overlapping variables will improve. This clarity can help clinicians tailor therapeutic approaches, thereby enhancing the efficacy of interventions aimed at individuals exhibiting traits associated with the Dark Triad, ultimately fostering more constructive outcomes in mental health care.

Additional AIHCP Blogs

Sociopathy and Psychopathy- Click here

 

Additional Resources

“Sociopath v. Psychopath: What’s the Difference?”. Kara Mayer Robinson. February 14th, 2022. WebMD. Access here

“Machiavellianism”. Psychology Today.  Access here

“What Is the Dark Triad? 9 Signs To Watch Out For” (2025).  Cleveland Clinic. Access here

Frothingham, M. (2024). “Dark Triad Personality Traits”. Simply Psychology.  Access here

Clinical Considerations in the Selection of Oral and Topical Antifungal Therapies for Onychomycosis

Posted on by Joseph Gerard

If you would like to become a certified case manager then please review the program and see how it matches your career needs

Written by Harry Wolf

Onychomycosis affects around 10 to 20 percent of the global population. It also makes up about 50 percent of all nail disorders, according to a 2025 report published by the International Journal of Advanced Biochemistry Research.

Age-related nail changes, reduced peripheral circulation, cumulative environmental exposure, and comorbid disease… They all contribute to the condition’s prevalence. 

Therapeutic decisions are rarely straightforward for clinicians. Efficacy, pathogen identification, comorbidities, drug interaction potential, laboratory monitoring requirements, adherence capacity, and cost… All influence selection between oral and topical antifungal therapies.

A Brief Overview of Onychomycosis

What exactly is onychomycosis? If you are not aware, here is the lowdown: it is a chronic fungal infection involving the nail plate, nail bed, and (in advanced cases) the nail matrix. 

Dermatophytes remain the most common etiologic agents, although non-dermatophyte molds and yeasts are increasingly identified in laboratory-confirmed cases, as detailed in an interesting analysis published by Nature’s Scientific Reports. 

Accurate organism identification has become increasingly important. Why is that? Quite simply, because therapeutic response varies by species.

Clinically, onychomycosis presents in several morphologic patterns. The following patterns influence both severity assessment and treatment selection:

  • Distal lateral subungual disease with progressive onycholysis
  • Superficial white onychomycosis affecting the dorsal nail plate
  • Proximal subungual disease
  • Total dystrophic onychomycosis in advanced and long-standing infections

Chronic fungal colonization can produce subungual hyperkeratosis, nail thickening, discoloration, and friability. Functional consequences include pain, difficulty ambulating, and impaired quality of life. 

In patients with diabetes, neuropathy, or peripheral arterial disease, thickened dystrophic nails may contribute to ulceration risk.

Diagnostic confirmation is recommended before initiating systemic therapy. 

Antifungal Therapies

Antifungal therapies for onychomycosis are categorized as systemic oral agents or topical transungual therapies. Selection should be determined by:

  • Disease severity
  • Nail matrix involvement
  • Organism type
  • Comorbidities
  • Patient preference

Systemic agents achieve therapeutic concentrations in the nail bed via bloodstream distribution. 

An evidence-based review, published by the National Library of Medicine, confirms that terbinafine, itraconazole, and fluconazole demonstrate clinically meaningful efficacy in treating onychomycosis. 

Cure rates? They are generally higher with systemic therapy in moderate-to-severe disease – compared with topical monotherapy.

Topical therapies act directly at the site of infection. A study published by Springer Nature demonstrated superior transungual penetration and antifungal activity of efinaconazole compared with tavaborole, ciclopirox, and several over-the-counter options. 

Penetration capacity is clinically relevant. Why? Because the nail plate presents a dense keratin barrier.

Therapeutic strategies? They may include:

  • Continuous oral dosing regimens lasting 6 to 12 weeks
  • Pulse-dosed oral therapy administered in treatment cycles
  • Daily topical application for 48 weeks or longer
  • Combination systemic and topical approaches in refractory cases

Mechanistically, allylamines such as terbinafine inhibit squalene epoxidase. They can lead to:

  • Ergosterol depletion
  • Fungal cell membrane disruption

Azoles such as itraconazole inhibit lanosterol 14-alpha-demethylase, thus impairing ergosterol synthesis. And oxaboroles such as tavaborole inhibit fungal protein synthesis by targeting leucyl-tRNA synthetase.

Understanding pharmacodynamics supports rational therapeutic selection – particularly in complex or recurrent cases, that is.

Selecting Oral Antifungal Therapies

When multiple nails, matrix involvement, or extensive subungual hyperkeratosis are present, systemic therapy remains a first-line approach. Treatment selection needs a high level of attention. 

It requires careful evaluation of:

  • Efficacy data
  • Safety profile
  • Comorbid disease
  • Drug interaction potential

The Comparative Efficacy of Oral Agents

Multiple comparative trials and meta-analyses demonstrate the following. Continuous oral terbinafine produces higher mycologic and complete cure rates than intermittent itraconazole in dermatophyte toenail onychomycosis.

A double-blind randomized clinical trial, published by the Institute of Tropical Medicine, is worth noting. It compared terbinafine 250 mg daily for 12 weeks with itraconazole 200 mg daily for 12 weeks. 

The study reported significantly higher negative mycology rates at 48-week follow-ups in the terbinafine group – 73% versus  46%, in fact. Plus, there were higher rates of near-total clinical cure as well. 

These findings support continuous terbinafine as a preferred first-line agent in dermatophyte-predominant disease.

Long-term follow-up data published in JAMA Dermatology further demonstrates that terbinafine can achieve significantly higher sustained mycologic and clinical cure rates, compared with itraconazole, that is. There were lower relapses observed over extended observation periods. 

Sustained clearance is clinically meaningful. And that is because? Recurrence contributes to repeated systemic exposure and cumulative cost.

Key comparative considerations? They include:

  • Higher sustained mycologic cure rates with continuous terbinafine
  • Lower relapse rates in long-term follow-up with terbinafine
  • Broader organism coverage with itraconazole
  • Dosing flexibility with pulse itraconazole regimens

Yes, itraconazole remains an effective alternative – particularly when non-dermatophyte molds or yeasts are implicated, that is. However… continuous terbinafine therapy continues to demonstrate superior efficacy outcomes in dermatophyte-associated toenail infection.

Safety Profiles and Monitoring

Oral antifungals… They require attention to hepatic safety and drug interaction potential. A safety-focused review published by the National Library of Medicine confirms that terbinafine and itraconazole are generally well tolerated but associated with rare hepatotoxic events. 

Hepatic injury is uncommon, yes. But it is clinically significant. So, it warrants appropriate screening.

Baseline liver-function testing is widely recommended before initiating systemic therapy. Monitoring intervals vary depending on the:

  • Duration of therapy
  • Patient-specific risk factors

Important safety considerations include:

  • CYP3A4 inhibition and interaction potential with itraconazole
  • Rare hepatotoxicity associated with terbinafine
  • Possible negative inotropic effects with itraconazole
  • Polypharmacy concerns in older adults

Special Populations and Comorbidities

Patients with diabetes… They represent a clinically significant subgroup. Thickened, dystrophic nails may increase pressure points and contribute to ulcer risk. 

Effective fungal eradication may reduce mechanical complications in this population.

Immunocompromised patients may experience atypical or proximal subungual presentations. Broader-spectrum coverage may be considered when non-dermatophyte pathogens are suspected.

Oral therapy may be less suitable in:

  • Active or chronic hepatic disease
  • History of medication-induced hepatotoxicity
  • Inability to adhere to monitoring protocols
  • Patient preference for localized therapy

Selecting Topical Antifungal Therapies

Topical therapy… It plays a central role in mild-to-moderate onychomycosis and in patients who cannot tolerate systemic agents. Localized therapy minimizes systemic exposure. However, it requires sustained adherence and realistic counseling regarding duration.

Indications for Topical Monotherapy

Topical monotherapy is typically reserved for limited nail involvement without matrix infection. Treatment duration often approaches 48 weeks because nail growth is slow and drug penetration through keratin is limited.

Appropriate candidates may include:

  • Involvement of less than 50 percent of a single nail
  • Absence of matrix involvement
  • Contraindications to systemic therapy
  • Preference to avoid systemic adverse effects

Comparative Effectiveness of Topical Agents

Let’s now reference laboratory evidence published by Springer Nature. It demonstrated significantly greater antifungal activity and transungual penetration for efinaconazole compared with tavaborole, ciclopirox, and evaluated over-the-counter products. 

Enhanced penetration may improve mycologic clearance – in carefully selected patients, that is.

Also, the study published by the  International Journal of Advanced Biochemistry Research, which we referenced earlier, emphasizes relapse risk and identifies adherence as a primary determinant of success. 

Prolonged daily application is required. For what reason? To maintain therapeutic drug levels in the nail plate.

Prescription options include:

  • Efinaconazole 
  • Tavaborole 
  • Ciclopirox 

Clinical selection depends on severity, penetration profile, and tolerability – as well as financial accessibility. So, if you are looking for products containing the active ingredient of efinaconazole, such as Jublia, for example, consider all those elements.

Reviewing the cost of Jublia at PricePro Pharmacy could assist patients in aligning their therapy with affordability.

Combination Therapy and Adjunctive Measures

Combination therapy may be considered in recalcitrant cases. Concomitant topical therapy during or after systemic treatment may reduce recurrence risk – by suppressing residual fungal elements, that is.

Adjunctive strategies? They include:

  • Mechanical debridement to reduce nail thickness
  • Regular trimming to decrease fungal burden
  • Treatment of concomitant tinea pedis
  • Environmental hygiene to reduce reinfection

Addressing concomitant skin infection reduces the likelihood of nail reinoculation.

Adherence 

Adherence remains a significant barrier in topical therapy. Daily application for extended periods requires sustained patient engagement.

Clinical reviews highlight:

  • Nearly year-long treatment timelines
  • Gradual cosmetic improvement rather than rapid change
  • Higher relapse rates compared with systemic therapy

Clear communication regarding expected time frames and visible milestones is crucial. Because? It improves persistence and therapeutic satisfaction.

Evolving Dermatophyte Resistance Patterns 

Emerging antifungal resistance is increasingly influencing clinical decision-making in onychomycosis management. Clinically relevant considerations include:

  • Refractory infection despite confirmed adherence
  • Recurrence shortly after completing systemic therapy
  • History of travel to areas with reported resistant strains
  • Prior prolonged or repeated terbinafine exposure

Itraconazole is frequently utilized as an alternative systemic agent when terbinafine resistance is suspected. In documented resistant cases, switching antifungal class has demonstrated clinical improvement. 

Molecular diagnostic tools and susceptibility testing may become increasingly relevant in tertiary-care and academic settings.

Also, antifungal resistance reinforces the importance of avoiding empiric systemic therapy without laboratory confirmation. Confirmed diagnosis prior to initiation minimizes unnecessary exposure. And it may reduce selective pressure that contributes to resistance development.

Recurrence Prevention and Long-Term Management 

Recurrence remains a persistent challenge in onychomycosis management. Even after an apparent clinical cure. 

Data indicates relapse rates of approximately 20 to 25 percent within two years following successful treatment, as summarized in that study published by the International Journal of Advanced Biochemistry Research. 

For clinicians, a durable cure requires attention beyond initial fungal eradication.

According to an article by Infection and Drug Resistance, recurrence may be influenced by:

  • Biofilm formation
  • Untreated concomitant tinea pedis
  • Persistent environmental reservoirs
  • Host factors such as immunosuppression or diabetes

Addressing those elements can improve long-term outcomes. 

Preventive strategies include:

  • Treating coexisting tinea pedis concurrently
  • Encouraging proper foot hygiene and drying practices
  • Disinfecting footwear and nail-care instruments
  • Monitoring high-risk patients periodically after cure

Patients with diabetes, peripheral vascular disease, or immunosuppression may require closer follow-ups. Why is that? Quite simply, it is due to elevated complication risk. 

Maintenance topical therapy following systemic treatment has been explored as a strategy to reduce recurrence, particularly in individuals with repeated relapse.

Environmental reinoculation also plays a role in recurrence. Shared showers, occlusive footwear, and persistent fungal reservoirs in socks or shoes may facilitate reinfection. Counseling patients about these risks will help to improve long-term therapeutic durability.

Recurrence prevention represents a shift from episodic treatment toward longitudinal management. Integrating preventive counseling into routine care:

  • Supports sustained remission
  • Reduces cumulative treatment burden

Applying Clinical Judgment in Onychomycosis Management

Let’s recap. Firstly, effective onychomycosis management requires individualized assessment – rather than protocol-driven uniformity, that is. 

Oral antifungal therapy generally provides higher complete cure rates in moderate-to-severe disease. Topical antifungal therapy offers a valuable alternative for localized infection or when systemic agents are contraindicated.

Diagnostic confirmation, organism identification, safety monitoring, adherence counseling, and financial accessibility… They all influence therapeutic success. 

Hopefully, this article has been helpful. If it has been, take a look at our other relevant content.

 

 

Author bio: Harry Wolf is a freelance writer. For almost a decade, he has written on topics ranging from healthcare to business leadership for multiple high-profile websites and online magazines.

 

References

  • Unauthored, 2022, Toenail Fungus, Cleveland Clinic.

https://my.clevelandclinic.org/health/diseases/11303-toenail-fungus

  • Unauthored, 2024, Toenail fungus (onychomycosis), Harvard Health Publishing.

https://www.health.harvard.edu/a_to_z/toenail-fungus-onychomycosis-a-to-z

  • Bodman, M. A., Syed, H. A., & Krishnamurthy, K., 2025, Onychomycosis, National Library of Medicine.

https://www.ncbi.nlm.nih.gov/books/NBK441853/

  • Sinha, R., Rathaur, H., & Mukhopadhyay, S., 2025, Onychomycosis focus in the elderly: Prevalence, diagnosis and treatment strategies, International Journal of Advanced Biochemistry Research.

https://www.biochemjournal.com/archives/2025/vol9issue6/PartB/9-5-104-852.pdf

  • Mayengo, R., Petra, N. P., Joseph, O., Ogwang, E., Kitunzi, G. M., Onguti, A. G., & Mirembe, S. K., 2025, Onychomycosis prevalence etiology and associated factors in women using nail cosmetics attending Mbarara regional referral hospital dermatology clinic Uganda, Nature.

https://www.nature.com/articles/s41598-025-30250-8

  • De Sa, D. C., Lamas, A. P., & Tosti, A., 2014, Oral therapy for onychomycosis: an evidence-based review, National Library of Medicine.

https://www.ncbi.nlm.nih.gov/books/NBK189719/

  • Elabbasi, A., Kadry, A., Joseph, W., Elewski, B., & Ghannoum, M., 2024, Transungual Penetration and Antifungal Activity of Prescription and Over-the-Counter Topical Antifungals: Ex Vivo Comparison, Springer Nature.

https://link.springer.com/article/10.1007/s13555-024-01237-6

  • De Backer, M., De Keyser, P., De Vroey, C., & Lesaffre, E., 1996, A 12-week treatment for dermatophyte toe onychomycosis: terbinafine 250 mg/day vs. itraconazole 200 mg/day – a double-blind comparative trial, Institute of Tropical Medicine Antwerp.

https://research.itg.be/en/publications/a-12-week-treatment-for-dermatophyte-toe-onychomycosis-terbinafin/

  • Sigurgeirsson, B., Ólafsson, J. H., Steinsson, J. Þ., Paul, C., Billstein, S., & Evans, E. G. V., 2001, Long-term Effectiveness of Treatment With Terbinafine vs Itraconazole in OnychomycosisA 5-Year Blinded Prospective Follow-up Study, JAMA Network.

https://jamanetwork.com/journals/jamadermatology/fullarticle/478735

  • Gupta, A. K., Haas-Neill, S., & Talukder, M., 2023, The safety of oral antifungals for the treatment of onychomycosis, National Library of Medicine.

https://pubmed.ncbi.nlm.nih.gov/37925672/

  • Axler, E., & Lipner, S. R., 2024, Antifungal Selection for the Treatment of Onychomycosis: Patient Considerations and Outcomes, Infection and Drug Resistance.

https://www.tandfonline.com/doi/pdf/10.2147/IDR.S431526

 

Please also review AIHCP’s Managed Health Care Consultant Certification program and CE courses see if it meets your academic and professional goals.  These programs are online and independent study and open to qualified professionals seeking a four year certification

3 Actionable Rules for Managing Unexpected Incidents in Care Settings 

Posted on by Joseph Gerard

Healthcare professionals certified in Pastoral Thanatology from AIHCP can better deliver bad news to patients and family with empathy and professionalism

Written by Deepika,

Unexpected incidents in care settings stand at the bittersweet intersection of reality and uncertainty. All seems to be going well until things spiral out of control at lightning speed. 

Now, healthcare professionals are not only trained for such events, but most are even familiar with the pressure points. However, that’s the thing about ‘the unexpected’, right? You never know what the next twist will be like. 

Such incidents may seem minor in isolation, but they add up quickly. This is why your response must be a carefully planned strategy of management, not an impulsive series of decisions. 

This article will outline three actionable rules that govern how unexpected situations in care settings should be managed. They will strengthen care for improved patient outcomes in the future. 

 

Timeliness and Safety Must Run Parallel to Each Other 

What’s the first rule of any healthcare service? It’s to do no harm. Now, unexpected incidents make this trickier as you must do no harm, but also as swiftly as possible. 

The implication here is that your quick response should not be made at the expense of safety. Since unplanned situations are part and parcel of healthcare, staff must be well-prepared. 2024 was a tragic year in the sense that 2.5 million non-fatal workplace injuries and illnesses were reported by private industry employers. 

Even one life lost is one too many, right? Every decision or move you and your team make should focus on preventing further harm to everyone involved. First, figure out what happened and who was affected by the event. Then, earmark any immediate dangers that loom over the affected. 

Equipment failure and heavy bleeding are two common examples of urgent risks. In the process, secure the environment by getting rid of hazards along the way. Basically, this is about anything you must do to make room for safer care.

Often, there may be scenarios where you sense a need for emergency intervention. If that’s the case, put the necessary protocols into action without delay. On that note, here are the essential steps to focus on: 

  • Stabilize the affected individual using relevant clinical measures. 
  • Look for additional support, especially if the situation is unclear or urgent. 
  • Adhere to the established protocols based on the event in question. 
  • Stick to clear communication lines with the rest of the care team. 
  • Provide reassurance to the patient and others involved to alleviate distress.

What you should be concentrating on is a calm and systematic approach. Your entire team can do the same through regular training sessions that facilitate razor-sharp discretion. 

 

Thorough Documentation With Full Context Is a Must 

With unforeseen incidents, you undoubtedly learn to keep accountability at the forefront. Only thorough documentation can enable that; however, it must include the complete context of the event. 

Always start by managing the incident, but follow it up with documentation that’s straightforward, crystal-clear, and factual. The importance of this step comes to light in real-life healthcare scenarios. For instance, in Ohio, around 77,100 workplace injuries and illnesses were reported in 2024. 

Tragically, the healthcare and social assistance sectors took the brunt of the blow. In dynamic care settings, which include cities like Toledo, such incidents are a part of daily operational reality. This is a direct connection to the importance of accurate reporting, one that remains objective to the letter.

If an incident results in harm, it may extend into considerations of accountability. This is where personal injury becomes relevant, especially since many healthcare incidents are later evaluated for medical negligence. 

As Zoll & Kranz, LLC, notes, negligence that leads to injuries makes the affected individual eligible for monetary compensation. Since securing fair compensation is not always a cakewalk, documentation becomes essential. 

Given our example, one may seek help from a Toledo personal injury lawyer to assess how care was delivered and where liability lies. For healthcare professionals, the following actions are of utmost importance: 

  • Work on documentation at the earliest to secure the most accurate details. 
  • Record facts in an objective manner without any assumptions. 
  • Be mindful of the institution’s reporting protocols. 
  • Make the document thorough and clear enough for an external review. 

 

There is No Way Around Steady Improvement 

Is the glass half-empty or full? In the world of healthcare, you cannot afford to hold the first perspective. The only way to keep up with patient needs is to consider each unexpected incident as an opportunity for growth. A recent study found that when hospitals focused on safety, over 300,000 additional patients survived care between April 2024 and March 2025. 

You won’t find any alternatives here, because weaknesses are usually not isolated loopholes. There is often plenty of room for better outcomes, provided you know how to avail of the chance. Consider a hypothetical scenario where a patient is given the wrong dose of medication during a busy shift. 

Fortunately, the error is recognized, and the patient is restored to a stable state. Should not this incident be documented? Well, in most cases, they will be, but that is the bare minimum. 

The example we shared calls for a 360-degree inspection into the matter. It may bring issues to the surface, like the medication labels looking similar or the nurse being interrupted during administration. 

Then, steps for rectification can be taken accordingly. If the former is the issue, careful storage and labeling would do the trick. If the latter, a mandatory cross-checking would suffice. 

There are not  ‘small issues’ in your field, so address them all at the earliest. In general, the following strategies for steady progress should help: 

  • Dig deeper into an incident using methods like root cause analysis. 
  • Look for any cracks in staffing or the environment. 
  • Ensure all procedures are up-to-date. 
  • Keep everyone in the loop, in real time. 
  • Fortify training measures in areas where glaring gaps are revealed. 
  • Discern changes in patient health to decide if the measures worked. 

 

Resist the urge to let panic have its way with your team. You can always take it slow as long as you don’t stall altogether. Keep matters in perspective by emphasizing one rule at a time.

Safety is a good starting point, which can be followed by documentation and analysis. Just stay the course, resisting the urge to skip any of the golden rules discussed here. In 2024, rates of incident reporting increased, reaching around 32.2 reports per 1,000 patient days in hospitals. 

Why such a dramatic change? One definite factor was that of learning from such incidents for a brighter future. Take your time, and the small actions will accumulate for the better. In due course, the unforeseen will have turned the tables for delivering safer care. 

Author Bio 

Passionate about words and learning, Deepika is a budding content creator who takes an interest in a variety of niches. Her knack for turning complex ideas into relatable narratives allows her to resonate with the reader. 

When her pen falls silent, you can find her engrossed in a novel or getting her hands messy with fine arts. By these, Deepika is committed to keeping her curiosity and creativity alive. 

 

 

Please also review AIHCP’s Crisis Intervention Certification program and our CE courses see if it meets your academic and professional goals.  These programs are online and independent study and open to qualified professionals seeking a four year certification