The course of treatment

2016 ◽  
pp. 139-152
Author(s):  
R. Peter Hobson
Keyword(s):  
Clinical Material ◽  
Initial Assessment ◽  
States Of Mind ◽  
Depth Of Focus ◽  
Therapist Communication ◽  
Over Time

Two final cases are presented, this time with a view to tracing the course of treatment from initial assessment to completion of therapy, both descriptively and through brief verbatim exchanges between patient and therapist. The aim is to achieve depth of focus, and complement a picture of the unfolding of psychotherapy over time with snapshots of more detailed clinical material. It is in slow but meaningful progress, manifest both in the scope and integration of a patient’s states of mind and in the coherence and depth of patient–therapist communication, that some of the most persuasive evidence for the value of treatment emerges.

scholarly journals Short-term storage of tiger salamander (Ambystoma tigrinum) spermatozoa: The effect of collection type, temperature and time

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0245047
Author(s):  
Amanda B. Gillis ◽  
Emmet L. Guy ◽  
Andrew J. Kouba ◽  
Peter J. Allen ◽  
Ruth M. Marcec-Greaves ◽  
...  
Keyword(s):  
Sperm Motility ◽  
Hormone Treatment ◽  
Effect Of Temperature ◽  
Initial Assessment ◽  
Ambystoma Tigrinum ◽  
Tiger Salamander ◽  
Storage Duration ◽  
Spermatozoa Motility ◽  
Over Time

The aims of this project were to characterize tiger salamander (Ambystoma tigrinum) spermatozoa motility over time, when excreted as either milt or spermic urine prior to packaging into a spermatophore, and to determine the effect of temperature on sperm motility. A split-plot design was utilized to assess the motility of the two pre-spermatophore sample types at two temperatures, 0°C and 20°C (n = 10 for each treatment). Spermiation was induced through exogenous hormone treatment of luteinizing hormone releasing hormone analog in order to collect both milt and spermic urine, which were evaluated for motility, divided into two separate aliquots, and subsequently stored in either an ice-bath (0°C) or on the benchtop (20°C). The decay rate of sperm motility was assessed by reevaluating subsamples at 0.5, 1, 2, 3, 5, 7, and 24 hours following the initial assessment. Results showed that sperm stored at 0°C had significantly higher progressive, non-progressive, and total motility for both sperm collection types over time. An interaction was found between collection type and time, with milt exhibiting lower initial motility that was more sustainable over time, compared to spermic urine. For both milt and spermic urine, motility decreased rapidly with storage duration, indicating samples should be used as soon as possible to maximize motility for in-vitro fertilization and cryopreservation. This is the first study to describe the differences in sperm motility between milt and spermic urine from an internally fertilizing caudate and demonstrates the benefits of near freezing temperatures on sperm longevity.

A first case history

2016 ◽  
pp. 37-51
Author(s):  
R. Peter Hobson
Keyword(s):  
Case History ◽  
Clinical Material ◽  
Initial Assessment ◽  
Psychoanalytic Therapy ◽  
First Case ◽  
Transference And Countertransference ◽  
History Of

The purpose of this chapter is to introduce Brief Psychoanalytic Therapy through the case history of a woman who presented with fatigue and a variety of medical ailments. Descriptions are given of the initial assessment consultation and then the course of 16 sessions of Brief Psychoanalytic Therapy. The clinical material represented illustrates both the therapist’s orientation and style of intervention, and the patient’s step-by-step development in the direction of more open, trusting, and fulfilling attitudes toward other people and the possibilities of life. The nature as well as the influence of the therapist’s focus on the transference and countertransference receive special attention.

scholarly journals L’italiano con i graffiti Patrimonio artistico-culturale: percorso per l’italiano L2

2021 ◽  
Author(s):  
Viola Monaci
Keyword(s):  
Language Learning ◽  
Teaching Strategies ◽  
Initial Assessment ◽  
Italian Language ◽  
Pragmatic Skills ◽  
The Relationship ◽  
Over Time

Over time, many models have been conceived to teach and evaluate the Italian language and Art culture for foreign learners and more recently for sectorial language learning. This paper is the result of research on specialist vocabulary and the acquisition of pragmatic skills through innovative, motivating teaching strategies, also useful for the enhancement of intrinsic skills of each learner. The corpus of the research includes: i. the implementation of an Italian L2 Art syllabus inspired by established models; ii. the results of experimentation based on a didactic module, in which graffiti were used as functional input for the learning; iii. the initial assessment of the relationship between iconic and linguistic codes aimed to improve the acquisition of skills in L2.

scholarly journals T99. HARNESSING DIGITAL TECHNOLOGIES TO ASSESS AND TREAT COGNITIVE SYMPTOMS IN SCHIZOPHRENIA

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S269-S269
Author(s):  
Cecelia Shvetz ◽  
Feng Gu ◽  
Jessica Drodge ◽  
John Torous ◽  
Synthia Guimond
Keyword(s):  
Cognitive Impairments ◽  
Digital Technologies ◽  
Smartphone Application ◽  
Initial Assessment ◽  
Great Promise ◽  
Cognitive Tests ◽  
Cognitive Symptoms ◽  
Clinical Implementation ◽  
Trail Making ◽  
Over Time

Abstract Background Cognitive impairments are a core feature of schizophrenia. Although cognitive impairments have consistently shown to have negative impacts on functional outcomes among individuals with schizophrenia, assessing and treating these symptoms in clinical settings remains a difficult challenge. Interestingly, the growing potential of new digital technologies, such as smartphone applications and virtual reality, hold great promise in alleviating these impairments. Methods This presentation will introduce results from two recent studies using digital technologies to assess and treat cognitive symptoms in schizophrenia. In the first study, smartphone versions of the pen-and-paper Trail Making Tests A and B were developed. These cognitive tests measure speed of processing and cognitive flexibility. We assessed the validity of the smartphone versions of both Trail Making Tests in measuring these cognitive domains in in 37 healthy controls and 26 individuals with schizophrenia. Following the initial assessment, participants were asked to complete the two smartphone cognitive tests once a week for three months. This served as a measure of cognitive performance over time Results Results showed that it was feasible to measure cognition using a smartphone application in schizophrenia. Performances on both smartphone cognitive tests were significantly and positively correlated with the pen-and-paper versions (Parts A: r = 0.65, p < .001; Parts B: r= 0.44, p= .01). Additionally, significant differences were observed between controls and individuals with schizophrenia on both smartphone tests (Part A: t = -3.88, p = .004; Part B: t = -3.29, p = .002). Moreover, longitudinal results showed no significant effect of practice over time on the smartphone cognitive tests. Discussion Digital technologies have the potential to optimize cognitive assessments, monitoring, and care in schizophrenia. Our findings support the feasibility and efficacy of using digital technologies to measure and treat cognitive impairments in schizophrenia. Our research also highlights the importance of including scientists, clinicians, and content experts with schizophrenia in the development of these tools to ensure their validity and facilitate clinical implementation.

scholarly journals State- and County-Level COVID-19 Public Health Orders in California: Constructing a Dataset and Describing Their Timing, Content, and Stricture

2020 ◽  
Author(s):  
Jeremy D. Goldhaber-Fiebert ◽  
Alexander F. Holsinger ◽  
Erin Holsinger ◽  
Elizabeth Long
Keyword(s):  
Public Health ◽  
Search Strategy ◽  
Initial Assessment ◽  
County Level ◽  
Data Set ◽  
Time Period ◽  
Rate Of Increase ◽  
Pharmaceutical Interventions ◽  
Over Time

AbstractWithout vaccines, non-pharmaceutical interventions have been the most widely used approach to controlling the spread of COVID-19 epidemics. Various jurisdictions have implemented public health orders as a means of reducing effective contacts and controlling their local epidemics. Multiple studies have examined the effectiveness of various orders (e.g. use of face masks) for epidemic control. However, orders occur at different timings across jurisdictions and some orders on the same topic are stricter than others. We constructed a county-level longitudinal data set of more than 1,700 public health orders issues by California and its 58 counties pertaining to its 40 million residents. First, we describe methods used to construct the dataset that enables the characterization of the evolution over time of California state- and county-level public health orders dealing with COVID-19 from January 1, 2020 through November 30, 2020. Public health orders are both an interesting and important outcome in their own right and also a key input into analyses looking at how such orders may impact COVID-19 epidemics. To construct the dataset, we developed and executed a search strategy to identify COVID-19 public health orders over this time period for all relevant jurisdictions. We characterized each identified public health order in terms of the timing of when it was announced, went into effect and (potentially) expired. We also adapted an existing schema to describe the topic(s) each public health order dealt with and the level of stricture each imposed, applying it to all identified orders. Finally, as an initial assessment, we examined the patterns of public health orders within and across counties, focusing on the timing of orders, the rate of increase and decrease in stricture, and on variation and convergence of orders within regions.

scholarly journals Using Strength and Risk Factors to Inform Treatment Typologies Over Time for Men on Community Supervision

2021 ◽  
pp. 0306624X2110274
Author(s):  
Kayla A. Wanamaker ◽  
Shelley L. Brown
Keyword(s):  
High Strength ◽  
Service Planning ◽  
Low Risk ◽  
Initial Assessment ◽  
Community Supervision ◽  
Transition Analysis ◽  
Childhood Experiences ◽  
Complex Needs ◽  
Low Strength ◽  
Over Time

This study examines treatment typologies over time and their relationship to reoffending outcomes. Latent transition analysis was conducted with 6,675 men on community supervision in Alberta, Canada using risk and strength factors measured by the Service Planning Instrument (Orbis Partners, 2003). Three timepoints were assessed: Time 1 = first assessment within 90 days of start of supervision, Time 2 = 3 to 8 months post initial assessment, and Time 3 = 9 to 14 months post initial assessment. Five profiles consistently emerged: Low risk/Low strength profile, Aggressive, complex need/Low strength profile, Moderate risk/Moderate strength profile, Low risk/High strength profile, and Non-aggressive, complex need/Low strength profile. At Time 3, a sixth profile emerged labeled Moderate complex need/Low strength. Profiles characterized as aggressive and those with complex needs had highest rates of reoffending. Results demonstrate the utility of incorporating strengths, mental health needs, and adverse childhood experiences in risk assessment protocols.

scholarly journals Acute Painless Jaundice: Assessment and Management

2008 ◽  
Vol 7 (3) ◽  
pp. 122-127
Author(s):  
Ceris Wyn Pritchard ◽  
◽  
Mike Webberley ◽  
Keyword(s):  
Fulminant Hepatic Failure ◽  
Systematic Approach ◽  
Initial Assessment ◽  
Emergency Setting ◽  
Biliary Disease ◽  
Common Presentation ◽  
Painless Jaundice ◽  
Medical Teams ◽  
Over Time ◽  
Key Questions

The most common presentation of liver and biliary disease is jaundice, and most acute medical teams will encounter several jaundiced patients over time. Some of these patients will be extremely unwell, and a systematic approach will enable all doctors to manage such patients correctly. Key questions should be addressed during initial assessment: i. Is the patient critically ill? ii. Does the patient have fulminant hepatic failure? iii. Is the jaundice secondary to an intra- or extrahepatic cause? This article aims to provide a guide to the assessment and management of the acutely jaundiced patient in the emergency setting…

scholarly journals Platelet Variability Index: A measure of platelet count fluctuations in patients with immune thrombocytopenia

2021 ◽  
Author(s):  
Na Li ◽  
Nancy M. Heddle ◽  
Ishac Nazy ◽  
John G. Kelton ◽  
Donald M. Arnold
Keyword(s):  
Platelet Count ◽  
Immune Globulin ◽  
Immune Thrombocytopenia ◽  
Performance Characteristics ◽  
Initial Assessment ◽  
High Dose ◽  
Severe Thrombocytopenia ◽  
Count Response ◽  
Variability Index ◽  
Over Time

Fluctuations in platelet count levels over time may help distinguish immune thrombocytopenia (ITP) from other causes of thrombocytopenia. We derived the platelet variability (PVI) score to capture both the fluctuations in platelet count measurements and the severity of the thrombocytopenia over time. Raw PVI values, ranging from negative (less severe thrombocytopenia and/or low fluctuations) to positive (more severe thrombocytopenia and/or high fluctuations) were converted to an ordinal PVI score, from 0 - 6. We evaluated performance characteristics of the PVI score for consecutive adults with thrombocytopenia from the McMaster ITP Registry. We defined patients with definite ITP as those who achieved a platelet count response after treatment with intravenous immune globulin or high dose corticosteroids; and possible ITP as those who never received ITP treatment or did not respond to treatment. Of 841 thrombocytopenic patients, 104 had definite ITP, 398 had possible ITP, and 339 had non-ITP thrombocytopenia. The median PVI score was 5 (interquartile range [IQR] 5, 6) for definite ITP; 3 (1, 5) for possible ITP; and 0 (0, 2) for non-ITP. A high PVI score correlated with the diagnosis of definite ITP even when calculated at the patient's initial assessment, before any treatment had been administered. Platelet count fluctuations alone contributed to the specificity of the overall PVI score. The PVI score may help clinicians diagnose ITP among patients with thrombocytopenia.

scholarly journals P.015 What Happens to the Worried Well? – Follow-up of Subjective Cognitive Impairment

2021 ◽  
Vol 48 (s3) ◽  
pp. S24-S24
Author(s):  
M Sutherland ◽  
A Kirk ◽  
C Karunanayake ◽  
M O’Connell ◽  
D Morgan
Keyword(s):  
Depression Scale ◽  
Epidemiologic Studies ◽  
Remote Memory ◽  
Initial Assessment ◽  
Significant Difference ◽  
Mini Mental Status Examination ◽  
One Year ◽  
Neurocognitive Decline ◽  
Over Time

Background: Concern around perceived neurocognitive decline is increasing, leading to increased number of referrals and anxiety for patients. We aimed to explore the likelihood of the “worried well” experiencing neurocognitive decline. Methods: 166 “worried well” patients who attended the Rural and Remote Memory Clinic between 2004 and 2019 were included. Mini Mental Status Examination, Center for Epidemiologic Studies Depression Scale, and Functional Assessment Questionnaire scores were measured and compared at initial assessment and at 1-year follow-up. MMSE scores over time were assessed with a mean follow-up of 2.95 years (SD 2.87). Results: There was no statistically significant difference in MMSE, CESD, or FAQ scores between clinic day and one-year follow-up, and no consistent pattern of MMSE score over time. Of the 166 patients with SCI on initial assessment, nine were eventually given a neurological diagnosis. Conclusions: There is no pattern of neurologic decline observed in the “worried well”. Though the likelihood of a patient with SCI developing a neurological diagnosis is reassuringly low, (9/166), it is not irrelevant. This, along with the benefits of early diagnosis and treatment for dementia, leads us to believe that patients with SCI should still be seen in follow-up at least at the one-year mark.

scholarly journals Effectiveness of treatment for 6813 patients with mental health conditions in Cambridgeshire: a cross-sectional study

BJPsych Open ◽  
2020 ◽  
Vol 6 (2) ◽  
Author(s):  
Nathan J. Dean ◽  
Nikitas Arnaoutoglou ◽  
Benjamin R. Underwood
Keyword(s):  
Mental Health ◽  
Treatment Effectiveness ◽  
Mental Healthcare ◽  
Cross Sectional Study ◽  
Initial Assessment ◽  
Cross Sectional ◽  
Data Set ◽  
Presenting Symptoms ◽  
The Uk ◽  
Over Time

Background The Health of the Nation Outcomes Scales (HoNOS) has been widely used as an outcome measure in UK mental health settings for the past decade. The data-set gathered provides a unique opportunity to evaluate the effectiveness of the totality of mental healthcare in ‘real-world’ conditions; much of our clinical evidence currently comes from highly parameterised clinical trials investigating single interventions in highly selected patients. Aims To examine all outcomes measured by HoNOS for a range of diagnostic groups, evaluate the influence of patient demographics on those outcomes, and observe changes in patient groups over time. Method Here we show the data from 6813 adult patients treated in Cambridgeshire between 2012 and 2017. Patients were split into three diagnostic groups: psychosis, non-psychosis and organic. Changes in HoNOS scores from initial assessment to discharge were tested and regressions were used to evaluate the influence of age, gender and ethnicity on the changes, as well as to model changes in the severity of initial presenting symptoms with time. Results HoNOS scores significantly improve after treatment for psychotic, non-psychotic and organic conditions in adults and older adults. Age, but not gender or ethnicity, influenced change in HoNOS scores. Patients entering secondary mental health services had increased initial HoNOS scores over time. Conclusions The UK repository of HoNOS scores provides a significant and relatively underutilised resource that can be exploited to gain insights into mental illness and treatment effectiveness. This is likely to have many applications, including influencing the commissioning of services.

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