Young clinicians dealing with death: Problems and opportunities

2015 ◽  
Vol 14 (5) ◽  
pp. 587-592
Author(s):  
Kathrine G. Nissen
Keyword(s):  
Case Report ◽  
Working Alliance ◽  
Psychological Intervention ◽  
Controlled Trial ◽  
Clinical Settings ◽  
Daily Work ◽  
Therapist Variables ◽  
Age Related ◽  
Patient Variables ◽  
Personal Insight

AbstractObjective:The formation of a strong bond between patients and therapists can lead to successful treatment outcomes. Yet, little is known about the mechanisms that function to control this relationship. The objective of this case report was to examine the ruptures and repairs in the working alliance between a young therapist and an elderly caregiver, and to suggest ways in which to deal with age-related challenges to such an alliance.Method:In order to examine the ruptures and repairs in a working alliance, this case report reflects on the interdependent relationship among therapist variables, patient variables, and the therapeutic alliance. The clinical experience presented describes a newly educated psychologist's struggles to overcome the challenges in forming a strong working alliance with an elderly dying cancer patient's spouse. The spouse was enrolled in the DOMUS study (Clinicaltrials.gov: NTC01885637), an ongoing randomized controlled trial of a patient-and-caregiver intervention for facilitating the transition from an oncology ward to palliative at-home care, and then bereavement. As part of the DOMUS study, the patient and spouse received a psychological intervention based on existential-phenomenological therapy.Results:A therapist's therapeutic approach to breaking down age-related barriers to communication matters greatly. The existential-phenomenological method of epoché offers a way to effectively address ruptures and repairs in a working alliance, as it enhances the therapist's openness to learning. In addition, the insights of senior supervisors can promote a therapist's openness to learning.Significance of results:In conclusion, the method of epoché benefits the working alliance in several ways, as it enhances personal insight and provides methods for repairing an alliance. The reflections in this paper may be applied to clinical settings in oncology, gerontology, and palliative care, which are likely to be of great interest to young clinicians experiencing age-related challenges in their daily work.

Age related volume of cadaver-prostates in Bangladesh

1970 ◽  
Vol 4 (2) ◽  
pp. 74-77
Author(s):  
Rukshana Ahmed ◽  
Shamim Ara
Keyword(s):  
Prostate Gland ◽  
Age Groups ◽  
Clinical Settings ◽  
Cross Sectional ◽  
Medical College ◽  
Age Related ◽  
Group A ◽  
Key Words Prostate ◽  
The Mean ◽  
Group B

Pathological changes in the prostate gland occur commonly with advancing age including inflammation, atrophy, hyperplasia and carcinoma and a change in volume is also evident. Estimation of volume of prostate may be useful in a variety of clinical settings. A cross-sectional descriptive study was designed to see the changes in volume of the prostate with advancing age and done in the Department of Anatomy, Dhaka Medical College, Dhaka from August 2006 to June 2007. The study was performed on 70 post-mortem human prostates collected from the unclaimed dead bodies that were under examination in the Department of Forensic Medicine, Dhaka Medical College, Dhaka. The samples were divided into three age groups; group A (10-20 years), group B (21-40 years) and group C (41-70 years). Volume of the sample was measured by using the ellipsoid formula. The mean ± SD volume of prostate was 7.68 ± 3.64 cm3 in group A, 10.61 ± 3.99 cm3 in group B and 15.40 ± 6.31 cm3 in group C. Mean difference in volume between group A and group C, group B and group C were statistically significant (p<0.001). Statistically significant positive correlation was found between age and volume of prostate (r = + 0.579, p < 0.001). Key Words: Prostate; volume; Bangladeshi. DOI: 10.3329/imcj.v4i2.6501Ibrahim Med. Coll. J. 2010; 4(2): 74-77

scholarly journals Lipid Lowering Therapy with Combination of Niacin and Statin in Women: Age-Related Endothelial Effects

2013 ◽  
Vol 2013 ◽  
pp. 1-7
Author(s):  
Beth Parker ◽  
Kamlesh Kothawade ◽  
Namee Kim ◽  
Maura Paul-Labrador ◽  
Noel Bairey Merz ◽  
...  
Keyword(s):  
Endothelial Function ◽  
Vascular Function ◽  
Controlled Trial ◽  
Pearson Correlation ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Cardiac Events ◽  
Double Blind ◽  
Lowering Therapy ◽  
Age Related

Background. Many women remain at risk for cardiac events despite treatment to reduce low-density lipoprotein cholesterol (LDL-C). We hypothesized that for postmenopausal women treated with niacin in addition to statin vascular function will improve. Methods. We conducted a randomized, double-blind, placebo-controlled trial of 16 weeks of niacin (N) versus placebo (PL) in 43 women (mean age, 67±9 years) previously on statin therapy. Study outcomes included lipoprotein levels, vascular inflammation assessed by high sensitivity C-reactive protein (hsCRP), interleukin 6 (IL-6), tumor necrosis factor α (TNF-α), and endothelial function, assessed as brachial artery flow mediated dilation (FMD). Results. The N group significantly increased HDL-C and decreased LDL-C cholesterol relative to PL (both P<0.01). FMD improved in both groups (P=0.02) irrespective of niacin (P=0.21). Age influenced change in FMD (P=0.01) such that improved FMD (before to after) with lipid lowering therapy was greater with older age (P=0.03 Pearson correlation = 0.34), independent of treatment group. Conclusions. Lipid lowering therapy with combination of niacin and statin does not improve inflammation or endothelial function compared to statin alone. However, older women demonstrate relatively greater endothelial benefit of lipid lowering therapy over 4 months. This trial is registered with Clinicaltrials.gov NCT00590629.

scholarly journals Nonsurgical Management of an Anterior Cruciate Ligament-Deficient Knee in a Women's Soccer Player: A Validation Clinical Case Report

2017 ◽  
Vol 52 (11) ◽  
pp. 1079-1083
Author(s):  
Courtney E. Gray ◽  
Chris Hummel ◽  
Todd Lazenby
Keyword(s):  
Randomized Controlled Trial ◽  
Anterior Cruciate Ligament ◽  
Case Report ◽  
Soccer Player ◽  
Controlled Trial ◽  
Cruciate Ligament ◽  
Meniscal Tear ◽  
Randomized Controlled ◽  
Anterior Cruciate ◽  
Acl Deficient

Background:  A collegiate women's soccer player sustained an isolated anterior cruciate ligament (ACL) tear and expressed a desire to continue her season without surgical intervention. Design:  Case report. Intervention(s):  Using the results of a randomized controlled trial and published clinical guidelines, the clinicians classified the patient as an ACL-deficient coper. The patient completed her soccer season without incident, consistent with the findings of the established clinical guidelines. However, 6 months later, she sustained a meniscal tear, which was not unexpected given that 22% of ACL-deficient copers in the randomized controlled trial incurred a meniscal tear within 24 months of ACL injury. Conclusion:  The external evidence was helpful in making informed clinical decisions regarding patient care.

scholarly journals Attachment-oriented psychological intervention for couples facing breast cancer: protocol of a randomised controlled trial

2014 ◽  
Vol 2 (1) ◽  
Author(s):  
Anne Nicolaisen ◽  
Dorte G Hansen ◽  
Mariët Hagedoorn ◽  
Henrik E Flyger ◽  
Nina Rottmann ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Randomised Controlled Trial ◽  
Psychological Intervention ◽  
Controlled Trial ◽  
Randomised Controlled

scholarly journals Effects of Treatment Preference on Adherence, Attrition, and Process Measures Among Older Adult Worriers

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 370-370
Author(s):  
Gretchen Brenes ◽  
Heidi Munger Clary ◽  
Michael Miller ◽  
Jasmin Divers ◽  
Andrea Anderson ◽  
...  
Keyword(s):  
Working Alliance ◽  
Behavioral Therapy ◽  
Controlled Trial ◽  
Treatment Preference ◽  
Process Measures ◽  
Treatment Expectancies ◽  
Intervention Adherence ◽  
The Stability ◽  
The Impact ◽  
Preference Trial

Abstract Patient preference may be related to treatment outcomes through decreased rates of attrition and higher rates of adherence and patient satisfaction. We present findings from a 2-stage randomized preference trial of cognitive-behavioral therapy (CBT) and yoga for the treatment of late-life worry. We examine rates of preference for CBT and yoga, as well as the stability of these preferences over time. We also examine the impact of preference on adherence, attrition, and process measures (satisfaction, treatment expectancies, and working alliance). Five hundred participants were randomized to either the randomized controlled trial (RCT; N=250) or the preference trial (participants chose the treatment; N=250). All participants received 10 weeks of an intervention. Among those in the preference trial, 48% chose CBT and 52% chose yoga (p&gt;.05). Strength of preference was similar between the groups; 73.3% and 76.2% reported a strong preference for CBT and yoga, respectively (p&gt;.05). Fourteen percent of those who preferred CBT at baseline preferred yoga upon completion of the intervention, while 12.2% of those who preferred yoga at baseline preferred CBT upon completion of the intervention (p&gt;.05). There were no significant differences between participants in the RCT and preference trial on intervention adherence, attrition, satisfaction, or working alliance (p’s&gt;.05). Treatment expectancies were higher for the preferred intervention (p’s&lt;.0001). Results suggest that older adults prefer CBT and yoga at similar rates, and these preferences are stable. Receiving a preferred treatment had no effect on adherence, attrition, satisfaction, or working alliance.

The conceptual invariance, trajectory, and outcome associations of working alliance in unguided and guided internet-based psychological interventions: A randomized controlled trial (Preprint)

2021 ◽  
Author(s):  
Xiaochen Luo ◽  
Matteo Bugatti ◽  
Lucero Molina ◽  
Jacqueline L. Tilley ◽  
Brittain Mahaffey ◽  
...  
Keyword(s):  
Working Alliance ◽  
Support Group ◽  
Behavioral Therapy ◽  
Controlled Trial ◽  
Post Treatment ◽  
Depression Symptoms ◽  
Therapy Program ◽  
Initial Sessions ◽  
Clinician Support

BACKGROUND The role of working alliance is largely unknown for internet-based interventions (IBI), an effective alternative for traditional psychotherapy. OBJECTIVE This study examined the conceptual invariance, trajectory, and outcome associations of working alliance in internet-based interventions incorporating or excluding clinician support via text or video. METHODS One hundred and forty-three adults with subclinical anxiety, stress, and/or depression symptoms were randomized to one of three treatment conditions for 7 weeks. All participants received access to MyCompass, an internet-delivered Cognitive Behavioral Therapy program. Participants in Condition 1 did not receive clinician support. Participants in Condition 2 and 3 received supplemental asynchronous clinician support via text or video respectively. Working alliance was measured weekly. Symptom outcomes were assessed at baseline, post-treatment, and 1-month follow-up. RESULTS We found scalar invariance of working alliance, indicating that working alliance was conceptually invariant across three conditions. Working alliance decreased significantly over time only in the text support group. Stronger baseline level and Faster increases in alliance predicted better outcomes at both post-treatment and follow-up only in the video support group. CONCLUSIONS Working alliance is methodologically comparable with or without clinician support and is generally established at initial sessions of IBI. Better alliance contributed to better outcomes only when clinician support is available via videos. CLINICALTRIAL clinicaltrials.gov ID: NCT05122429

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