Melanie Klein

2020 ◽  
Author(s):  
Malby Oliver
Keyword(s):  
Group Analysis ◽  
Young Patients ◽  
Clinical Work ◽  
Original Method ◽  
Interdisciplinary Studies ◽  
Melanie Klein ◽  
Clinical Encounters ◽  
Psychoanalytic Treatment ◽  
Unique Object ◽  
Child Psychoanalysis

Melanie Klein (b. 1882–d. 1960) proposed a revolutionary way of thinking about children and child psychoanalysis that led to discoveries related to the understanding of the functioning, structure, and growth of the mind, as well as an original method for the psychoanalytic treatment of children. The creation of her play technique redefined child psychoanalysis, transformed adult psychoanalysis, and opened new areas including the psychoanalysis of psychosis, autism and borderline conditions, group analysis, and interdisciplinary studies on issues that affect the child’s world. Klein started working with children at a time when child analysis occupied a marginal position in psychoanalysis; children were considered unanalyzable, or in danger if analyzed. Klein’s freedom of thought led her to test psychoanalytic theory and method in her clinical encounters with children, resulting in her concept of the child as a unique object of psychoanalytic treatment and investigation. Her radically original approach to child analysis facilitated the study and treatment of the earliest and deepest functioning of the psyche. The infant was conceived of as born with its objects and with an ego from birth, equipping the infant with the capacity to relate, to love, and to hate the other, to differentiate between me and not-me, inside and outside, and to phantasize. Klein’s theory of the paranoid-schizoid and depressive positions is a theory on changes in the link between the ego and its objects and ensuing anxieties. The task in development is to master this related anxiety and transform it into language and thought, this occurring in the context of the relationship with the mother/other/analyst. Klein took children extremely seriously. Her child clinical material offers vivid descriptions of the child’s mind and the contact she made with challenging young patients. Klein had an obvious passion for clinical work and curiosity about the child’s unconscious discourse, her intuition, and capacity for observation. Available for the child, playing out the roles attributed to her, adhering to phantasy, receiving positive and negative transferences, intuitively registering anxiety and interpreting it: Klein gives meaning to the child’s experience. The main focus of this article is on the relevance of Kleinian discourse for the study of the child and the thinking on the needs of and dangers affecting children in the 21st century.

scholarly journals ACE2 Expression in Kidney and Testis May Cause Kidney and Testis Damage After 2019-nCoV Infection

2020 ◽  
Author(s):  
Caibin Fan ◽  
Kai Li ◽  
Yanhong Ding ◽  
Wei Lu ◽  
Jianqing Wang
Keyword(s):  
Renal Function ◽  
Young Patients ◽  
Clinical Work ◽  
Testicular Tissue ◽  
Kidney Damage ◽  
Function Evaluation ◽  
Renal Tubular Cells ◽  
Renal Tubular ◽  
Novel Coronavirus ◽  
Potential Pathogenicity

AbstractIn December 2019 and January 2020, novel coronavirus (2019-nCoV) - infected pneumonia (NCIP) occurred in Wuhan, and has already posed a serious threat to public health. ACE2 (Angiotensin Converting Enzyme 2) has been shown to be one of the major receptors that mediate the entry of 2019-nCoV into human cells, which also happens in severe acute respiratory syndrome coronavirus (SARS). Several researches have indicated that some patients have abnormal renal function or even kidney damage in addition to injury in respiratory system, and the related mechanism is unknown. This arouses our interest in whether coronavirus infection will affect the urinary and male reproductive systems. Here in this study, we used the online datasets to analyze ACE2 expression in different human organs. The results indicate that ACE2 highly expresses in renal tubular cells, Leydig cells and cells in seminiferous ducts in testis. Therefore, virus might directly bind to such ACE2 positive cells and damage the kidney and testicular tissue of patients. Our results indicate that renal function evaluation and special care should be performed in 2019-nCoV patients during clinical work, because of the kidney damage caused by virus and antiviral drugs with certain renal toxicity. In addition, due to the potential pathogenicity of the virus to testicular tissues, clinicians should pay attention to the risk of testicular lesions in patients during hospitalization and later clinical follow-up, especially the assessment and appropriate intervention in young patients’ fertility.

Culture as a Multidimensional Construct

2019 ◽  
pp. 13-36
Author(s):  
Anne Emmerich ◽  
Leslie Tarver
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Health Care Workers ◽  
Life Experience ◽  
Cultural Influences ◽  
Clinical Work ◽  
Self Awareness ◽  
Clinical Encounters ◽  
Implicit Biases ◽  
Care Workers

Despite years of training about how to care for others, many health care providers know little about themselves. This is nowhere more relevant than when caring for patients who come from cultures other than our own because in these clinical encounters, we may not recognize our own implicit biases. Our cultural identity as health care workers is multifaceted, including attitudes shaped by our life experience and those shaped by the culture of our health care system. This chapter discusses the concepts of culture and cultural self-awareness and introduces strategies that health care workers can use to understand their own cultural influences and consider how these may be impacting their clinical work. We present a case example that exemplifies the principles outlined in the chapter.

scholarly journals The role of physician assistants in pediatric emergency medicine: the physician's view

CJEM ◽  
2013 ◽  
Vol 15 (06) ◽  
pp. 321-329 ◽  
Author(s):  
Quynh Doan ◽  
Shalea Piteau ◽  
Sam Sheps ◽  
Joel Singer ◽  
Hubert Wong ◽  
...  
Keyword(s):  
Emergency Department ◽  
Clinical Work ◽  
Physician Assistants ◽  
Pediatric Emergency ◽  
Cross Sectional ◽  
Survey Tool ◽  
Clinical Encounters ◽  
Clinical Conditions ◽  
Selection Of

ABSTRACTObjective:To define the range of clinical conditions Canadian emergency pediatricians consider appropriate formanagement by physician assistants (PAs) and the degree of autonomy PAs should have in the pediatric emergency department (PED).Methods:We conducted a cross–sectional, pan-Canadian survey using electronic questionnaire technology: the Active Campaign Survey tool. We targeted PED physicians using the Pediatric Emergency Research Canada (PERC) network database (N = 297). Three outcome measures were assessed: demographic information, familiarity with PAs, and PA clinical roles in the PED. The level of PA involvement was assessed for 57 common nonemergent clinical conditions.Results:Of 297 physicians, 152 completed the survey, for a response rate of 51.2%. None of the 57 clinical categories achieved at least 85% agreement regarding PA management without direct physician involvement. Twenty-four clinical conditions had ≥ 15% agreement that any PA involvement would be inappropriate. For the remaining 33 clinical conditions, more than 85% of respondents felt that PA could appropriately manage but were divided between requiring direct and only indirect physician supervision. Respondents' selection of the number of conditions felt to be appropriate for PA involvement varied between the size of the emergency department (ED) in which they work (larger EDs 87.7–89.1% v. smaller EDs 74.2%) and familiarity with the clinical work of PAs in the ED (90.5–91.5% v. 82.2–84.7%).Conclusion:This national survey of Canadian PED physicians suggests that they feel PAs could help care for a large number of nonemergent clinical cases coming to the PED, but these clinical encounters would have to be directly supervised by a physician.

scholarly journals Predictors of Clinical Course and Outcomes of Acute Diverticulitis: The Role of Age and Ethnicity

Medicina ◽  
2021 ◽  
Vol 57 (11) ◽  
pp. 1269
Author(s):  
Randa Taher ◽  
Yael Kopelman ◽  
Abdel-Rauf Zeina ◽  
Amir Mari ◽  
Fadi Abu Baker
Keyword(s):  
Multivariate Analysis ◽  
Acute Diverticulitis ◽  
Group Analysis ◽  
Age Groups ◽  
Young Patients ◽  
Distal Colon ◽  
Young Age ◽  
First Episode ◽  
Complicated Course ◽  
The Impact

Background and Objectives: Acute diverticulitis (AD) is the leading and most burdensome complication of colonic diverticulosis. However, risk factors for its development and predictors of its course are still poorly defined. In this regard, the association of a young age with a complicated course and worse outcome are still controversial. Moreover, little research has addressed the effect of ethnicity on the course of AD. The current study aimed to evaluate the impact of these variables on AD’s course and outcome in the diverse and unique ethnic landscape of Israel. Materials and Methods: We performed a retrospective review of the charts of patients with a radiologically confirmed diagnosis of AD. Patients’ outcomes and disease course, including hospitalization duration, complications, and recurrent episodes, were documented and compared among different age and ethnic groups. Multivariate analysis was performed to identify predictors of complicated AD. Results: Overall, 637 patients with AD were included, the majority (95%) had distal colon AD, and almost one quarter of them were aged less than 50 years. The majority of patients in the young age (<50) group were males (69.7%). Nonetheless, the rate of recurrent episodes (35.3% vs. 37.3%, p = 0.19), hospitalization duration (5 ± 4.7 vs. 6 ± 3.2, p = 0.09) and complications rate (17.3% vs. 13.7%; p = 0.16) were similar for both age groups. In the ethnicity group analysis, Arab minority patients had a first episode of AD at a significantly younger age compared to their Jewish counterparts (51.8 vs. 59.4 years, p < 0.001). However, factors such as a complicated course (16% vs. 15%; p = 0.08) and relapsing episode rates (33% vs. 38%; p = 0.36) did not differ significantly between groups. None of the variables, including young age and ethnic group, were predictors of complicated AD course in the multivariate analysis. Conclusion: AD is increasingly encountered in young patients, especially in ethnic minority groups, but neither ethnicity nor young age was associated with worse outcomes.

scholarly journals The Long-Term Financial and Clinical Impact of an Electronic Health Record on an Academic Ophthalmology Practice

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Michele C. Lim ◽  
Roma P. Patel ◽  
Victor S. Lee ◽  
Patricia D. Weeks ◽  
Martha K. Barber ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Work Productivity ◽  
Clinical Work ◽  
Health Record ◽  
Patient Visit ◽  
Clinical Encounters ◽  
Financial Gain ◽  
Time Period ◽  
Electronic Health ◽  
The Difference

Purpose.To examine financial and clinical work productivity outcomes associated with the use of the electronic health record (EHR).Methods.191,360 billable clinical encounters were analyzed for 12 clinical providers over a 9-year study period during which an EHR was implemented. Main outcome measures were clinical revenues collected per provider and secondary outcomes were charge capture, patient visit coding levels, transcription costs, patient visit volume per provider, digital drawing, and digital imaging volume.Results.The difference in inflation adjusted net clinical revenue per provider per year did not change significantly in the period after EHR implementation (mean = $404,198; SD = $17,912) than before (mean = $411,420; SD = $39,366) (P=0.746). Charge capture, the proportion of higher- and lower-level visit codes for new and established patients, and patient visits per provider remained stable. A total savings of $188,951 in transcription costs occurred over a 4-year time period post-EHR implementation. The rate of drawing the ophthalmic exam in the EHR was low (mean = 2.28%; SD = 0.05%) for all providers.Conclusions.This study did not show a clear financial gain after EHR implementation in an academic ophthalmology practice. Ophthalmologists do not rely on drawings to document the ophthalmic exam; instead, the ophthalmic exam becomes text-driven in a paperless world.

scholarly journals Acupuncture and Lifestyle Myopia in Primary School Children—Results from a Transcontinental Pilot Study Performed in Comparison to Moxibustion

Medicines ◽  
2018 ◽  
Vol 5 (3) ◽  
pp. 95 ◽  
Author(s):  
Xiaojuan Shang ◽  
Luquan Chen ◽  
Gerhard Litscher ◽  
Yanxia Sun ◽  
Chuxiong Pan ◽  
...  
Keyword(s):  
Pilot Study ◽  
Group Analysis ◽  
Young Patients ◽  
Computer Work ◽  
Primary School Children ◽  
Public Health Issue ◽  
Complementary Methods ◽  
Acupuncture And Moxibustion ◽  
Significant Difference ◽  
Before And After

Background: Lifestyle risks for myopia are well known and the disease has become a major global public health issue worldwide. There is a relation between reading, writing, and computer work and the development of myopia. Methods: Within this prospective pilot study in 44 patients aged between 6 and 12 years with myopia we compared possible treatment effects of acupuncture or moxibustion. The diopters of the right and left eye were evaluated before and after the two treatment methods. Results: Myopia was improved in 14 eyes of 13 patients (15.9%) within both complementary methods. Using acupuncture an improvement was observed in seven eyes from six patients out of 22 patients and a similar result (improvement in seven eyes from seven patients out of 22 patients) was noticed in the moxibustion group. The extent of improvement was better in the acupuncture group (p = 0.008 s., comparison before and after treatment); however, group analysis between acupuncture and moxibustion revealed no significant difference. Conclusions: Possible therapeutic aspects with the help of evidence-based complementary methods like acupuncture or moxibustion have not yet been investigated adequately in myopic patients. Our study showed that both acupuncture and moxibustion can improve myopia of young patients. Acupuncture seems to be more effective than moxibustion in treating myopia, however group analysis did not prove this trend. Therefore, further Big data studies are necessary to confirm or refute the preliminary results.

scholarly journals Audit on availability, quality and frequency of clincal and educational supervision

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S79-S79
Author(s):  
Gayathri Gnanasekaram ◽  
Amanda Hoar
Keyword(s):  
Clinical Supervision ◽  
Clinical Work ◽  
Clinical Encounter ◽  
Junior Doctors ◽  
Improvement Project ◽  
Medical Environment ◽  
Clinical Encounters ◽  
Survey Responses ◽  
User Friendly

AimsGMC defines clinical supervisor as a trainer who is responsible for overseeing a specified trainee's clinical work throughout a placement in a clinical or medical environment and is appropriately trained to do so¹.This AUDIT aimed to review the frequency, content and quality of clinical supervision for psychiatric trainees within Somerset NHS Foundation Trust. Both Severn deanery and Somerset NHS Foundation Trust both recommend psychiatry trainees have one hour of supervision per week, involving exploration of trainee clinical and educational needs.MethodAll trainees working in Somerset NHS Foundation Trust psychiatry from February 2020 were invited to participate. A survey was designed to quantify the frequency of supervision amongst this cohort. Survey online software, SurveyMonkey, was chosen for the accessibility and user friendly modality and disseminated via email to all junior doctors (n = 27). Survey responses were collected in the last month of the placement (July–August 2020).Questions on accomplishing workplace based assessments (WPBA), managing e-portfolio requirements were asked, with Likert scale responses available. Quality of supervision was explored via white space answers.Surveys were reviewed by the AUDIT authors and descriptive data collected.Result63% trainees responded (17 out of 27). Educational objectives were discussed at the beginning of the placement. Over half the respondents stated that time was not set aside to look at e-portfolio.Workplace based assessments (WBPAs), and Case based discussions (CBDs) were more frequently achieved than observed assessments of clinical encounters (ACEs/Mini-ACEs) (assessment of clinical encounter).30% core psychiatry trainees respondents (4 out of 7) discussed their audits/QI projects with their supervisors most/always. 42% (3 out of 7) had a discussion sometimes.2 GP and foundation trainees stated they were unable to obtain community mental health experience. The response rate to this question was disappointing and we think it may be secondary to the pressures of the pandemic.100% respondents described educational supervisors as supportive and approachable.ConclusionWhilst all respondents found their supervisors approachable and supportive, completion of formal WPBAs and portfolio reviews was suboptimal.Following regional presentation of results, the pertinence of these findings for all trainees was highlighted. A supervision template has been created and extension of this initial audit to a regional quality improvement project is underway.Specific recommendations included brief and regular supervisor check-ins with trainees regarding projects and psychotherapy competencies and a mid-placement review of portfolio.

The Collected Works of D. W. Winnicott

2016 ◽  
Keyword(s):  
Male Patient ◽  
Melanie Klein ◽  
False Self ◽  
Psychoanalytic Treatment

Volume 6 (1960–1963) is introduced with an essay by British adult and child analyst Angela Joyce, current chair of the Winnicott Trust. This volume contains one of Winnicott’s most important papers, ‘The Theory of the Parent-Infant Relationship’, along with papers on aggression, the false self, guilt, adolescence, time in psychoanalytic treatment, the capacity for concern, the value of dependence, fear of breakdown, and communicating and not communicating. It also includes Winnicott’s reassessment of Melanie Klein, a discussion of envy in a male patient, and a range of letters to colleagues and others.

scholarly journals ACE2 Expression in Kidney and Testis May Cause Kidney and Testis Infection in COVID-19 Patients

2021 ◽  
Vol 7 ◽  
Author(s):  
Caibin Fan ◽  
Wei Lu ◽  
Kai Li ◽  
Yanhong Ding ◽  
Jianqing Wang
Keyword(s):  
Young Patients ◽  
Clinical Work ◽  
Function Evaluation ◽  
Binding Assays ◽  
Angiotensin Converting Enzyme 2 ◽  
Renal Tubular Cells ◽  
New Type ◽  
Testicular Lesions ◽  
Renal Tubular

In December 2019, a new type of pneumonia caused by SARS-Cov-2 (COVID-19) occurred in Wuhan and has been discovered in many countries around the world. ACE2 (angiotensin-converting enzyme 2) has been shown to be one of the major receptors that mediate the entry of SARS-Cov-2 into human cells. Here in this study, we used the online datasets to analyze ACE2 expression in different human organs. The results indicated that ACE2 highly expresses in renal tubular cells, Sertoli cells, Leydig cells, and cells in seminiferous ducts in testis. Recombinant SARS-CoV-2 spike protein (RBD) domain and ACE2 of RPTEC/SerC cell-binding assays confirmed that SARS-Cov-2 can bind to ACE2 on the surface of these cells. Our results suggest that ACE2 expression could contribute to kidney and testis infection after COVID-19 infection. Renal function evaluation and special care should be performed during clinical work. Clinicians should also pay attention to the risk of testicular lesions in patients during hospitalization and later clinical follow-up, especially the assessment and appropriate intervention in young patients' fertility.

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