“Where are the Nine?”

1996 ◽  
Vol 24 (3) ◽  
pp. 179-196 ◽  
Author(s):  
Randall Lehmann Sorenson
Keyword(s):  
Clinical Practice ◽  
John Bunyan ◽  
The One

Jesus’ questions as recorded in the Gospels offer a prophetic challenge for Christian therapists who seek to integrate their faith with their clinical practice. One of my favorites is Jesus’ question in Luke 17 to the one leper who returned after all ten had been healed: “Where are the nine?” John Bunyan (1678/1969) in his classic The Pilgrim's Progresshad his protagonist, an Everyman he named “Christian,” traverse an allegorical odyssey en route to the Celestial City past adversarial characters with names like “Ignorance,” “Pliable,” and “Obstinate.” Taking inspiration from Bunyan, I propose putting the lepers in Luke to similarly imaginative use, recasting them for my purposes here as ten invented characters who represent different but common responses to the notion that integration is something indivisbly, irreducibly, and fundamentally personal. It is my thesis that we run from this notion just as the lepers ran from Christ. I have divided the lepers into four “colonies”: three of three lepers each, and the tenth as a colony of one. In this article I address the first two colonies, which I have named “No Need” and “No Good.”

scholarly journals The Diagnosis and Therapy of Degenerative Knee Joint Disease: Expert Consensus from the Chinese Pain Medicine Panel

2018 ◽  
Vol 2018 ◽  
pp. 1-14 ◽  
Author(s):  
Dong Huang ◽  
Yan-Qing Liu ◽  
Li-Shuang Liang ◽  
Xue-Wu Lin ◽  
Tao Song ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Diagnosis And Treatment ◽  
Joint Disease ◽  
Knee Joints ◽  
Reproduction Rate ◽  
Pain Specialist ◽  
Chinese Association ◽  
The One ◽  
Almost All ◽  
Based Medicine

At present, there are many constantly updated guidelines and consensuses on the diagnosis and treatment of osteoarthritis both at home and abroad. The recommendations established using methods of evidence-based medicine has experienced strict research on controlling bias and promoting reproduction rate. As a result, the previous evidence was reevaluated, and a lot of changes were provoked in the diagnosis and treatment concept of osteoarthritis. However, several methods not recommended by foreign guidelines are still in use in the current clinical practice in China. On the one hand, Chinese experts have not reached extensive consensus on whether it is necessary to make changes according to foreign guidelines. On the other hand, almost all the current relevant guidelines are on osteoarthritis, but the lesions around knee joints which, as a whole, bear the largest weight in human body, cannot be ignored. For this purpose, Chinese Association for the Study of Pain (CASP) organized some leading experts to formulate this Chinese Pain Specialist Consensus on the diagnosis and treatment of degenerative knee osteoarthritis (DKOA) in combination with the guidelines in foreign countries and the expert experience of clinical practice in China. The consensus, which includes the definition, pathophysiology, epidemiology, clinical manifestation, diagnostic criteria, and treatments of DKOA, is intended to be used by first-line doctors, including pain physicians to manage patients with DKOA.

scholarly journals ‘Thrown in at the Deep End’: The Experience of Graduates of Transnational Western Medical Education Transitioning into Middle Eastern Clinical Practice

2019 ◽  
Vol 8 (6) ◽  
pp. 36
Author(s):  
Fiza Rashid-Doubell ◽  
Timothy P Doubell
Keyword(s):  
Medical Education ◽  
Clinical Practice ◽  
Cultural Context ◽  
Middle Eastern ◽  
Phenomenological Approach ◽  
Full Time ◽  
Host Countries ◽  
Medical Teams ◽  
The One ◽  
And Coping

Background: Newly qualified doctors educated in their home country usually go on to work in their first hospital job in same country. These graduates are familiar with the socio-cultural context of clinical setting they work in. But, with many Western universities providing cross-border education to host countries in the Middle East and South East Asia in subjects such as medicine. The experiences of those graduating from transnational medical education and working in local hospitals are absent.The aim of the study was to explore the early transitional experiences of newly qualified doctors moving from a European branch campus to practice at hospitals affiliated to the medical school situated in a Middle-Eastern country.Methods: A qualitative study using an interpretive phenomenological approach through interviews to explore experiences of graduates of transnational medical education working in Middle Eastern hospitals. Results: The main findings can be summarised under the three themes generated: the essentials of practice, routine of practice and realities of practice. The results evidenced the transition as a challenging period for new doctors finding dissonance between the skills taught while in transnational education and the workplace. There were three particular areas of discord for the graduates in clinical practice: working in medical teams with a different arrangement to the one prepared for; adapting to a more patient-centred language and coping with differences in ethical norms, values and practices in the hospital.Conclusions: The graduates found transitioning from university to full-time clinical practice difficult and were disappointed by their experience not matching their expectations of work. These findings are valuable for transnational medical educators seeking to improve the experience of graduates who are moving from the clear ideals, norms and values of transnational medical education into the complexity of full-time clinical practice.  

Diverse Dimensions of the Cotard’s Syndrome - an Approach Towards a Clear Classification of the Phenomenon

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
A. Nagy ◽  
V. Voros ◽  
T. Tenyi
Keyword(s):  
Clinical Practice ◽  
Diagnostic Category ◽  
Treatment Strategies ◽  
Differential Diagnostics ◽  
Dimensional System ◽  
Central Feature ◽  
Scientific Databases ◽  
Search Terms ◽  
The One

Aim:The authors present the Cotard's syndrome, a rare psychiatric condition, pointing out the latest results in terms of psychoneurology and classification of the phenomenon. The central feature of the syndrome is a nihilistic delusion, in which the patient denies his or her own existence and that of the external world.Method:We searched electronic scientific databases using the appropriate search terms; relevant articles were carefully reviewed. We also present three cases from our clinical practice.Results:After the overview of the latest biological and neuropsychological findings, the terminology, the nosology, the classification and the differential diagnostics are discussed. To sum up with useful information for the clinical practice, the possible treatment strategies, the course and the prognosis of the disease are also presented.Conclusions:The reported cases together with the reviewed literature suggest that a dimensional system of classifying Cotard's syndrome is preferable. At the one end of the spectrum is the presence of the pure nihilistic delusions, appearing as a symptom of an underlying psychiatric or neurological condition. The full-blown, classical syndrome as a diagnostic category forms the other end of the spectrum. The presented theoretical and practical aspects give a lead on deeper understanding, easier recognition and more adequate therapy of the Cotard's syndrome.

scholarly journals Trainees' experiences of a Balint group

2003 ◽  
Vol 27 (7) ◽  
pp. 274-275 ◽  
Author(s):  
Arthita Das ◽  
Paul Egleston ◽  
Hany El-Sayeh ◽  
Michelle Middlemost ◽  
Narinder Pal ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Psychotherapy Training ◽  
Discussion Group ◽  
Patient Relationship ◽  
Positive Experience ◽  
Case Discussion ◽  
Everyday Clinical Practice ◽  
The One ◽  
Balint Group ◽  
Balint Method

Psychotherapy training is mandatory before trainees can gain membership of the Royal College of Psychiatrists. One type of introduction to psychotherapy is via a case discussion group, such as the one pioneered by Michael Balint. Much has been published regarding psychotherapy training, but little describing the Balint method from a trainee's perspective. Our paper outlines trainees' experiences of participating in this type of group. The group encouraged trainees to think about the doctor–patient relationship in their everyday clinical practice. All of those who finished the group described a positive experience, giving a good grounding for further psychotherapy training.

scholarly journals Communicating Guideline Recommendations Using Graphic Narrative Versus Text-Based Broadcast Screensavers: Design and Implementation Study (Preprint)

2021 ◽  
Author(s):  
Lauren Sinnenberg ◽  
Craig A Umscheid ◽  
Frances S Shofer ◽  
Damien Leri ◽  
Zachary F Meisel
Keyword(s):  
Clinical Practice ◽  
High Volume ◽  
Suppressive Therapy ◽  
Guideline Recommendation ◽  
Graphic Narrative ◽  
Design And Implementation ◽  
Resident Physicians ◽  
Graphic Narratives ◽  
The One ◽  
The Impact

BACKGROUND The use of graphic narratives, defined as stories that use images for narration, is growing in health communication. OBJECTIVE The aim of this study was to describe the design and implementation of a graphic narrative screensaver (GNS) to communicate a guideline recommendation (ie, avoiding low-value acid suppressive therapy [AST] use in hospital inpatients) and examine the comparative effectiveness of the GNS versus a text-based screensaver (TBS) on clinical practice (ie, low-value AST prescriptions) and clinician recall. METHODS During a 2-year period, the GNS and the TBS were displayed on inpatient clinical workstations. The numbers of new AST prescriptions were examined in the four quarters before, the three quarters during, and the one quarter after screensavers were implemented. Additionally, an electronic survey was sent to resident physicians 1 year after the intervention to assess screensaver recall. RESULTS Designing an aesthetically engaging graphic that could be rapidly understood was critical in the development of the GNS. The odds of receiving an AST prescription on medicine and medicine subspecialty services after the screensavers were implemented were lower for all four quarters (ie, GNS and TBS broadcast together, only TBS broadcast, only GNS broadcast, and no AST screensavers broadcast) compared to the quarter prior to implementation (odds ratio [OR] 0.85, 95% CI 0.78-0.92; OR 0.89, 95% CI 0.82-0.97; OR 0.87, 95% CI 0.80-0.95; and OR 0.81, 95% CI 0.75-0.89, respectively; <i>P</i>&lt;.001 for all comparisons). There were no statistically significant decreases for other high-volume services, such as the surgical services. These declines appear to have begun prior to screensaver implementation. When surveyed about the screensaver content 1 year later, resident physicians recalled both the GNS and TBS (43/70, 61%, vs 54/70, 77%; <i>P</i>=.07) and those who recalled the screensaver were more likely to recall the main message of the GNS compared to the TBS (30/43, 70%, vs 1/54, 2%; <i>P</i>&lt;.001). CONCLUSIONS It is feasible to use a graphic narrative embedded in a broadcast screensaver to communicate a guideline recommendation, but further study is needed to determine the impact of graphic narratives on clinical practice.

Delusion

2018 ◽  
Author(s):  
Lisa Bortolotti ◽  
Rachel Gunn
Keyword(s):  
Clinical Practice ◽  
Psychiatric Disorders ◽  
Philosophy Of Mind ◽  
Prediction Error ◽  
Clinical Context ◽  
Philosophical Literature ◽  
Belief Report ◽  
Causal History ◽  
History Of ◽  
The One

In a clinical context, delusions are symptoms of a number of psychiatric disorders including schizophrenia and dementia, manifesting as beliefs that are implausible and resistant to counter-evidence. In the philosophical literature, the nature of delusions (what they are) and their formation (what causes them) have been examined with increasing interest. Different arguments for and against delusions being regarded as beliefs have been put forward, and both the doxastic and the anti-doxastic camp capture some distinctive and puzzling features of delusions. The one-factor theory, the two-factor theory, and the prediction-error theory constitute distinct attempts to describe the causal mechanisms responsible for the formation of delusions and have implications for the management and treatment of delusions in clinical practice. The lively debates surrounding the nature and the causal history of delusions have also shed some light on standard issues in the philosophy of mind, such as what conditions a report needs to satisfy to be regarded as a belief report, and how experience and reasoning interact in generating of hypotheses that can then be accepted as beliefs.

Introduction

2018 ◽  
Author(s):  
Michael Davies
Keyword(s):  
Civil Liberties ◽  
Second World War ◽  
John Bunyan ◽  
World War ◽  
Future Directions ◽  
The Past ◽  
Historical Figure ◽  
Literature Culture ◽  
The One ◽  
Second World

This chapter introduces The Oxford Handbook of John Bunyan. It reflects upon Bunyan’s ‘presence’ as a religious and historical figure and an author of major significance for literature, culture, and politics, both in the past and the present, in Britain and across the world. It contests the oft-alleged myth that Bunyan’s relevance has waned dramatically since the Second World War, being popular now, we are often told, only within academia and among evangelicals. By contrast, this chapter considers the living ‘resonance’ of Bunyan’s writings and of his legacy both in and for art, literature, and popular culture now in the broader terms of human rights and civil liberties, on the one hand, and a ‘memorial dynamics’ and the ‘portability’ of his works on the other. This chapter addresses the rationale behind this volume, explains its structure, summarizes its contents, and reflects too upon some future directions for ‘Bunyan studies’.

Projective Kit for Early Childhood (P. K. E. C.)

2011 ◽  
Vol 32 (2) ◽  
pp. 223-251 ◽  
Author(s):  
Pascal Roman ◽  
Mathilde Dublineau ◽  
Camila Saboia
Keyword(s):  
Early Childhood ◽  
Clinical Practice ◽  
Young Children ◽  
Clinical Research ◽  
Autism Spectrum ◽  
The Other ◽  
Research Practice ◽  
Consultation Process ◽  
Clinical Consultation ◽  
The One

This article highlights, on the one hand, the relevance of the Projective Kit for Early Childhood – a projective play test – in the dual prospect of research practice, and of clinical practice, on the other hand, considering a form of continuity between both these processes, as stressed by C. Chabert (1995 ). First, a brief introduction to this unique test in the field of psychopathology in young children serves to assess the relevance of this projective device in clinical practice and research. Then we successively present the test’s implications in actual clinical research, involving an evaluation of the psychoaffective dynamics of children with West syndrome (a form of epilepsy occurring in infants from the early stages of life, which impairs their development and frequently leads to psychopathological pictures in the autism spectrum) and as part of a clinical consultation process focused on the problem of depression.

The Metaphor of Dissociation: Teleological, Phenomenological, Structural, Dynamical

2019 ◽  
pp. 72-105 ◽  
Author(s):  
Ellert R.S. Nijenhuis
Keyword(s):  
Clinical Practice ◽  
Present Article ◽  
Internal Consistency ◽  
Substance Dualism ◽  
Enactive Approach ◽  
Conceptual Clarity ◽  
Original Definition ◽  
Structural Dissociation ◽  
The One ◽  
Definition Of

Dissociation as used in psychology and psychiatry is a troubled conceptual metaphor. The main problems include conflicting definitions and a lack of internal consistency of some of these formulations. Trying to mend the situation, Van der Hart, Nijenhuis and Steele (2006) revisited Janet's original definition of dissociation, and referred to it as "structural dissociation of the personality". This term is not meant to suggest that "structural dissociation" involves a particular kind of dissociation as is sometimes thought. To prevent or repair further misunderstanding, in the present article I highlight four inherent features of dissociation of the personality: teleological, phenomenological, structural, and dynamical. The article alsoaims to bridge some metaphors that are commonly described and understood as dichotomies, implying dualisms that plague philosophy, science, and clinical practice. For example, personality is understood as an organism-environment system, involving subjects and "objects" (that may be other subjects) as co-dependent and co-constitutive partners. Regarding matter (brain/body) and mind as attributes of one substance reflects an attempt to avoid the problems of philosophical (substance) dualism, as well as the one-sidedness of philosophical materialism and idealism. The generation, maintenance, and elaboration ofdissociation is analyzed in terms of causing, that is, the mutual manifestation of a network of reciprocal powers. The joint analyses involve an enactive approach to life, and intend to achieve further conceptual clarity and consistency of the metaphor of dissociation.

scholarly journals Trainees' experiences of a Balint group

2003 ◽  
Vol 27 (07) ◽  
pp. 274-275 ◽  
Author(s):  
Arthita Das ◽  
Paul Egleston ◽  
Hany El-Sayeh ◽  
Michelle Middlemost ◽  
Narinder Pal ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Psychotherapy Training ◽  
Discussion Group ◽  
Patient Relationship ◽  
Positive Experience ◽  
Case Discussion ◽  
Everyday Clinical Practice ◽  
The One ◽  
Balint Group ◽  
Balint Method

Psychotherapy training is mandatory before trainees can gain membership of the Royal College of Psychiatrists. One type of introduction to psychotherapy is via a case discussion group, such as the one pioneered by Michael Balint. Much has been published regarding psychotherapy training, but little describing the Balint method from a trainee's perspective. Our paper outlines trainees' experiences of participating in this type of group. The group encouraged trainees to think about the doctor–patient relationship in their everyday clinical practice. All of those who finished the group described a positive experience, giving a good grounding for further psychotherapy training.

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