Five Months Later: The Psychodynamic Psychiatrist and Psychiatric Care in the Era of COVID-19

2020 ◽  
Vol 48 (4) ◽  
pp. 363-391
Author(s):  
Kimberly Best ◽  
Douglas H. Ingram
Keyword(s):  
Social Justice ◽  
Clinical Practice ◽  
Psychiatric Care ◽  
Initial Burst ◽  
Content Of Care ◽  
Training Structure ◽  
The Impact ◽  
And Training ◽  
Virtual Treatment

Five months following an earlier report on the initial impact of COVID-19, the same 24 contributing psychodynamic psychiatrists reported on how matters have shifted in their experience. Spread of the virus, lockdowns, politicization of all aspects of the pandemic, massive unemployment, and social justice frustrations have characterized the interim. The initial burst of acute uncertainty and worry has shifted into a more adaptive but still destabilizing long-term apprehension: distance treatment and its ramifications have become somewhat normalized, training now incorporates virtual treatment approaches, psychodynamically informed counseling has taken a larger role in the content of care. New theories of clinical practice are emerging that address these changes. As before, contributors’ narratives are considered from the perspective of administration and training, structure and content of treatment, and the impact of the pandemic both on patients and psychiatrists.

scholarly journals ANALYSIS OF METEOROLOGICAL CONDITIONS SIGNIFICANT FOR SMALL AVIATION AND TRAINING FLIGHTS AT THE AIRFIELD “BALKHASH” FOR PLANNING AND FLIGHT SAFETY PURPOSES

2021 ◽  
Vol 2 (446) ◽  
pp. 62-67
Author(s):  
N. Dolzhenko ◽  
E. Mailyanova ◽  
I. Assilbekova ◽  
Z. Konakbay
Keyword(s):  
Meteorological Conditions ◽  
Flight Safety ◽  
The Past ◽  
The Republic ◽  
The Impact ◽  
And Training ◽  
Term Data ◽  
Small Aircraft

Cloudiness and range of visibility are the most significant flight conditions for aircraft. The impact of clouds and visibility on the safety of aircraft flights, especially small aircraft, cannot be overestimated. According to the Interstate Air Committee, Kazakhstan ranks second in the number of aviation disasters. The average age of a third of Kazakhstan's small aircraft is more than 30 years. Over the past few years, 14 air accidents have occurred in the Republic of Kazakhstan, 11 of them with small aircraft. In this work, we investigate long-term data on cloudiness and visibility at the most weather-favorable airfield in Balkhash, for the possibility of safe and economical flights of small aircraft and planning training flights.

scholarly journals Peritoneal Morphology after Long-Term Peritoneal Dialysis with Biocompatible Fluid: Recent Clinical Practice in Japan

2012 ◽  
Vol 32 (2) ◽  
pp. 159-167 ◽  
Author(s):  
Nobuhiro Ayuzawa ◽  
Yoshitaka Ishibashi ◽  
Yutaka Takazawa ◽  
Haruki Kume ◽  
Toshiro Fujita
Keyword(s):  
Peritoneal Dialysis ◽  
Clinical Practice ◽  
University Hospital ◽  
Dialysis Therapy ◽  
Compact Zone ◽  
Peritoneal Biopsy ◽  
The Mean ◽  
The Impact ◽  
Peritoneal Morphology

♦BackgroundMorphology changes of the peritoneal membrane after long-term peritoneal dialysis (PD) consist of denudation of peritoneal mesothelial cells, interstitial sclerosis, and hyalinizing vasculopathy. Those changes are considered to be the result of uremia and bioincompatible effects of conventional acidic lactate-buffered dialysate with glucose degradation products (GDPs). In the last decade, biocompatible dialysate with neutral pH and low GDPs has become widely used. Clinical practice has been modified in Japan, especially for anuric patients, and now includes the use of hybrid therapy. The impact on peritoneal morphology has not been well reported.♦ ObjectiveThe aim of the present study was to investigate the long-term effect on peritoneal morphology and function of biocompatible fluid use and current clinical practice in Japan, including hybrid dialysis therapy.♦MethodsWe evaluated peritoneal biopsy specimens from patients who had undergone PD for more than 3 years. We used the average peritoneal thickness (APT) of the submesothelial compact zone as a marker of interstitial sclerosis and the lumen/vessel diameter ratio (L/V ratio) at postcapillary venules as a marker of hyalinizing vasculopathy. Demography and other data for the patients, including dialysate-to-plasma (D/P) ratio of creatinine, were obtained at baseline and every 6 months by peritoneal equilibration test.♦ResultsBetween 2002 and 2009, 110 patients started PD therapy with biocompatible dialysate at Tokyo University Hospital. Among them, 11 patients (8 men, 3 women; age: 54.2 ± 11.8 years; 1 with diabetes mellitus) were enrolled into this morphology study. The mean duration of PD in this group was 61 ± 11.3 months, and the mean time to peritoneal biopsy was 58 ± 15.1 months. The median APT was 180 μm (96 – 1424 μm), and the median L/V ratio was 0.66 (0.46 – 0.74). No obvious correlations between APT, L/V ratio, and PD duration were detected. The D/P creatinine of the 11 patients was maintained at a favorably low value, comparable with that of the other 99 patients.♦ConclusionsPeritoneal dialysis therapy using biocompatible dialysate in conjunction with modification of clinical practice may minimize the progression of peritoneal interstitial sclerosis and hyalinizing vasculopathy, preserving favorable peritoneal function for more than 3 years.

The Impact of Culture and Social Justice on Christian Formation in Pentecostalism

2015 ◽  
Vol 24 (2) ◽  
pp. 201-216
Author(s):  
Wolfgang Vondey
Keyword(s):  
Social Justice ◽  
Latin America ◽  
North America ◽  
Socioeconomic Factors ◽  
Social Activism ◽  
Cultural Influences ◽  
Christian Formation ◽  
The Impact

The essay contrasts two distinct ways of Pentecostal formation: (1) social activism and (2) social passivism. The former identifies Christian formation as participation and leadership in the struggle against poverty, deprivation, and oppression; the latter withdraws into a sectarian mindset of individualism, self-improvement, and triumphalism. A focus on Asia, Africa, Latin America, and North America brings the two accounts into dialogue on the identity of contemporary Pentecostal formation. The results suggest that Christian formation among Pentecostals is confronted with significant diversity influenced by cultural and socioeconomic factors. Johns’ classic study of Pentecostal formation and its emphasis on conscientization leading to redemptive participation in the struggle among the oppressed demands further attention. This essay shows that conscientization among Pentecostals is not only a psychological and sociocritical form of assessment but a personal and communal coming to consciousness subject to long-term cultural influences and sociohistorical developments.

scholarly journals Deep inspiration breath hold versus free breathing technique in mediastinal radiotherapy for lymphoma

BJR|Open ◽  
2021 ◽  
Vol 3 (1) ◽  
pp. 20200067
Author(s):  
Orla Anne Houlihan ◽  
Guhan Rangaswamy ◽  
Mary Dunne ◽  
Christine Rohan ◽  
Louise O'Neill ◽  
...  
Keyword(s):  
Spinal Cord ◽  
At Risk ◽  
Clinical Practice ◽  
Organs At Risk ◽  
Free Breathing ◽  
Breath Hold ◽  
Deep Inspiration ◽  
Deep Inspiration Breath Hold ◽  
The Impact

Objective: Radiotherapy plays an important role in the management of lymphoma and many patients with lymphoma are cured with treatment. Risk of secondary malignancy and long-term cardiac and pulmonary toxicity from mediastinal radiotherapy exists. Delivery of radiotherapy using a deep inspiration breath-hold (DIBH) technique increases lung volume and has the potential to reduce dose to heart and lungs. We undertook a prospective study to assess the dosimetric differences in DIBH and free breathing (FB) plans in patients requiring mediastinal radiotherapy in clinical practice. Methods: We performed both FB and DIBH planning scans on 35 consecutive patients with mediastinal lymphoma needing radiotherapy. Contours and plans were generated for both data sets and dosimetric data were compared. All patients were planned using volumetric modulated arc therapy (VMAT). Data were compared for FB and DIBH plans with each patient acting as their own control using the related-samples Wilcoxon signed rank test. Results: DIBH significantly reduced lung doses (mean 10.6 vs 11.4Gy, p < 0.0005; V20 16.8 vs 18.3%, p = 0.001) and spinal cord maximum dose (20.6 vs 22.8Gy, p = 0.001). DIBH increased breast V4 (38.5% vs 31.8%, p = 0.006) and mean right breast dose (4.2 vs 3.6Gy, p = 0.010). There was no significant difference in heart doses when the entire study cohort was considered, however, mean heart dose tended to be lower with DIBH for upper mediastinal (UM) tumours (4.3 vs 4.9Gy, p = 0.05). Conclusion: Our study describes the potential benefit of DIBH in a population reflective of clinical practice. DIBH can decrease radiation dose to lungs, heart and spinal cord, however, may increase dose to breasts. DIBH is not always superior to FB, and the clinical significance of differences in dose to organs at risk in addition to the time required to treat patients with DIBH must be considered when deciding the most appropriate radiotherapy technique for each patient. Advances in knowledge: To our knowledge, this is the largest study comparing DIBH and FB planning for patients with lymphoma receiving mediastinal radiotherapy in clinical practice. It demonstrates the impact of an increasingly common radiotherapy technique on dose to organs at risk and the subsequent potential for long-term radiotherapy side-effects.

scholarly journals Contemporary Medical Education: Revolution Versus Evolution

2021 ◽  
Author(s):  
Louis Maximilian Buja
Keyword(s):  
Medical Education ◽  
Clinical Practice ◽  
Academic Medicine ◽  
Disruptive Innovation ◽  
Long Term Outcomes ◽  
The Social ◽  
Medical Education System ◽  
Traditional Approaches ◽  
The Impact

Contemporary and traditional approaches to undergraduate medical education (UME) and graduate medical education (GME) are compared and differences are highlighted. A case is made that the contemporary medical education system is being subject to the downside of disruptive innovation with unintended and potentially detrimental long-term outcomes for academic medicine and clinical practice. The impact on various constituencies is discussed. Proposed solutions are presented. The challenges for education of the best possible physicians are daunting but must be met to honor the social contract between medicine and society.

The Impact of Telehealth on the Healthcare Workforce

2011 ◽  
pp. 180-192
Author(s):  
Sisira Edirippulige ◽  
Rohana Marasinghe ◽  
Siti Noorsuriani Maon ◽  
Yoshikazu Fujisawa
Keyword(s):  
Health Workforce ◽  
Infrastructure Development ◽  
Access To Health Services ◽  
Access To Health ◽  
Critical Issues ◽  
Global Concern ◽  
The Impact ◽  
And Training

The pressures on the health workforce have a profound impact on the quality of care. The solution to health workforce issues is a global concern and governments and health systems around the world are seeking solutions to the problems of worker shortages and access to health services. Education and training of more doctors, nurses, and other health professionals require long-term policy changes, funding, and infrastructure development. Telehealth has been identified as an alternative solution to address some of these critical issues and this chapter outlines the potential of telehealth to address some challenges facing the health workforce. The discussion will provide evidence for feasible and effective adoption of telehealth solutions.

Examining the relationship between neuropsychological functioning assessed during admission to a high secure psychiatric care hospital and vulnerability to long-term segregation

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Ishbel McMichael ◽  
Olivia Tiley ◽  
Josephine Broyd ◽  
David Murphy
Keyword(s):  
Psychiatric Care ◽  
Neuropsychological Functioning ◽  
Care Hospital ◽  
Early Assessment ◽  
Content Type ◽  
Subsequent Time ◽  
Secure Psychiatric Care ◽  
The Impact ◽  
The Relationship

Purpose This paper aims to examine the relationship between neuropsychological functioning as assessed following admission to a high secure psychiatric care (HSPC) hospital and subsequent time spent in long-term segregation (LTS). Evidence from forensic populations suggests neuropsychological functioning difficulties can increase vulnerability to interpersonal violence. However, the impact of this relationship on restrictive interventions used in these settings is poorly understood. Design/methodology/approach This study quantitatively examined the neuropsychological profiles of 80 male HSPC patients as assessed during routine admission assessments, comparing data against any subsequent LTS duration during a one-year period, and a non-LTS control (n = 27). Findings Analysis found individuals who were willing and able to complete a routine neuropsychological admissions assessment spent significantly less time in LTS than those unable to complete the assessment. Performance within a test of novel problem solving (Key Search Test) was significantly worse in the LTS group than controls. Performance within a visual memory task (Immediate Recall section of the Rey Complex Figure Test) significantly correlated with LTS duration. Additional findings suggest the absence of self-reported planning difficulties as measured by a Dysexecutive Questionnaire (DEX) negatively correlated with LTS duration, while self-reported restlessness was positively correlated with LTS. Practical implications This has implications for early assessment of LTS risk and potential use of cognitive interventions to reduce the use of restrictive practices. Originality/value The results suggest some aspects of neuropsychological performance as assessed during admission to a HSPC hospital appear to be related to subsequent time spent in LTS.

scholarly journals Efficacy, Safety and Long-term Outcomes of Nicorandil Use in Patients with Stable Ischemic Heart Disease According to the Results of Randomized and Observational Studies

2019 ◽  
Vol 15 (5) ◽  
pp. 641-648
Author(s):  
Yu. V. Lukina ◽  
N. P. Kutishenko ◽  
S. Yu. Martsevich
Keyword(s):  
Heart Disease ◽  
Clinical Practice ◽  
Comparative Analysis ◽  
Ischemic Heart Disease ◽  
Ischemic Heart ◽  
Long Term Outcomes ◽  
Stable Ischemic Heart Disease ◽  
The Impact ◽  
Real Clinical Practice

Working Group of the NIKEA Study. Yekaterinburg: Akulina E.N., Reznik I.I.; Izhevsk: Grebnev S.A., Yezhov A., Shinkareva S.E.; Krasnodar: Kudryashov E.A., Skibitsky A.V., Skibitsky V.V., Fendrikova A.V.; Krasnoyarsk: Altayev V.D., Matyushin G.V., Nemik D.B., Pitaev R.R., Samokhvalov E.V., Stolbikov Yu.Yu.; Moscow: Balashov I.S., Voronina V.P., Gaisenok O.V., Dmitrieva N.A., Zagrebelny A.V., Zakharova A.V., Zelenova T.I., Kolganova E.V., Leonov A.S., Lerman O.V., Maximova M.A., Sladkova T.A., Shestakova G.N.; Novosibirsk: Kuimov A.D., Shurkevich A.A.; Omsk: Goodilin V.A., Loginova E.N., Nechaeva G.I.; Orel: Zhuravleva L.L., Lobanova G.N., Luneva M.M., Mitroshina T.N.; Orenburg: Kondratenko V.Yu., Libis R.A.; Rostov-on-Don: Dubishcheva N.F., Kalacheva N.M., Kolomatskaya O.E., Romadina G., Skarzhinskaya N.S., Chesnikova A.I., Chugunova I.B.; Ryazan: Dobrynina N.V., Nikolaev A.S., Trofimova Ya.M., Yakushin S.S.; Tula: Berberfish L.D., Gomova T.A., Gorina G.I., Dabizha V.G., Zubareva L.A., Nadezhkina K.N., Nikitina V.F., Renko I.E., Soin I.A., Yunusova K.N.Background. Nicorandil is an antianginal drug for which, the ability to positively influence the prognosis of patients (pts) with stable ischemic heart disease (IHD) was confirmed in a randomized controlled trial (RCT) of IONA (the Impact Of Nicorandil in Angina). To study whether the results of RCTs are reproduced in real clinical practice seems to be an actual scientific and practical task.Aim. To compare the data on the effectiveness and safety of nicorandil in pts with stable IHD obtained in the NIKEA observational study (OS) and in the IONA randomized study.Material and methods. 590 pts with IHD and stable angina pectoris were included in the OS NIKEA. All pts were recommended to take nicorandil in addition to the standard antiischemic therapy. 21 months after being included in the study, 524 pts received a phone call. During the telephone contact with pts or their relatives, the life status of pts was determined. According to these results of the survey data were obtained, that 15 people died and 509 pts were alive. The events included in the primary combined endpoint (PCEP) were also determined: death from all causes, new cases of acute myocardial infarction and acute cerebrovascular accident, unscheduled operations of myocardial revascularization, hospitalization for decompensation of chronic heart failure, atrial fibrillation, unstable angina, information on taking nicorandil and other drug therapy, adverse events of drug treatment have been reported. A comparative analysis of the results of the OS NIKEA and RCT IONA was carried out. The results of the IONA study were taken according to the publication in the Lancet 2002. A comparative analysis of the results of the effectiveness of nicorandil in real practice (according to the OS results) was performed with the data obtained in the RCT: the nicorandil/placebo groups in the RCT were compared with the adherent/non-adherent nicorandil groups in the OS.Results. The follow-up duration in both studies was similar and averaged 1.6±0.5 years at RCT IONA and 1.8±0.4 years at NIKEA study. The average age of pts was 67,0±8,0 years in RCT and 65.1±9.6 years in OS. In pts of OS more pronounced comorbidity was noted (cardiovascular diseases, diabetes mellitus). Drugs that favorably affect the prognosis in pts with IHD were more often prescribed to NIKEA study pts (p<0.05). In both RCTs and OS, the antianginal effectiveness of nicorandil was confirmed. According to the OS results, a reduction in the number of angina attacks and a decrease in the need for short-acting nitrates were demonstrated. The frequency of PCEP components was higher in RCT.Conclusion. Long-term outcomes according to the NIKEA observational program for various components of the PCEP turned out to be similar to the results of RCT IONA. It is demonstrated the efficacy of nicorandil in real clinical practice. 

scholarly journals Vocational education, transitions, marginalisation and social justice in the Nordic countries: Reflections on the special issue

2019 ◽  
Vol 18 (3) ◽  
pp. 376-384 ◽  
Author(s):  
James Avis
Keyword(s):  
Social Justice ◽  
Vocational Education ◽  
Education And Training ◽  
Nordic Countries ◽  
Vocational Education And Training ◽  
Academic Education ◽  
Special Issue ◽  
Just Society ◽  
The Impact ◽  
And Training

This paper engages with and reflects on the arguments developed by contributors to the special issue. These papers serve to provide a corrective to English and, on occasion, European perceptions, which often view the Nordic countries as being all of a piece and beacons of progressivism. The contributors provide analyses that not only point to the impact of neo-liberalism upon vocational education and training but also the different ways in which it is delivered across the Nordic countries. They alert us to vocational education and training’s complexity and varied forms. Nevertheless, it appears there are a set of repertoires that can be mobilised to address the relationship between vocational education and training and youth transitions to work and vocational study, which seem to circulate across time and place. The circulation of these models suggests they fail to address the deeper issues facing vocational education and training, namely the relation of it in particular and ‘academic’ education in general to capitalism, and, importantly, the salience of these processes in the current conjuncture. These relations raise questions about the reproduction of class relations and the specificity of the socio-economic contexts. This leads to a consideration of notions of social justice and an interrogation of vocational education and training with this particular question in mind. An important issue that needs to be explored is the way in which the curriculum opens up or closes down access to powerful knowledge. Whilst education, in Bernstein’s words, ‘cannot compensate for society’, can it nevertheless be a resource in the transformative struggle for a just society?

scholarly journals Pragmatic neuroscience for clinical psychiatry

2019 ◽  
Vol 215 (01) ◽  
pp. 404-408 ◽  
Author(s):  
J. Douglas Steele ◽  
Martin P. Paulus
Keyword(s):  
Mental Health ◽  
Machine Learning ◽  
Substance Use ◽  
Clinical Practice ◽  
Routine Clinical Practice ◽  
Pragmatic Approach ◽  
And Training ◽  
Program Grant ◽  
Significant Mortality

SummaryMental health and substance use disorders are the leading cause of long-term disability and a cause of significant mortality, worldwide. However, it is widely recognised that clinical practice in psychiatry has not fundamentally changed for over half a century. The Royal College of Psychiatrists is reviewing its trainee curriculum to identify neuroscience that relates to psychiatric practice. To date though, neuroscience has had very little impact on routine clinical practice. We discuss how a pragmatic approach to neuroscience can address this problem together with a route to implementation in National Health Service care. This has implications for altered funding priorities and training future psychiatrists. Five training recommendations for psychiatrists are identified.Declaration of interestJ.D.S. receives direct funding from MRC Program Grant MR/S010351/1 aimed at developing machine learning-based methods for routinely acquired NHS data and indirect funding from the Wellcome Trust STRADL study. M.P.P. receives payments for an UpToDate chapter on methamphetamine and is principal investigator on the following grants: NIGMS P20GM121312 and NIDA U01 DA041089 and receives support from the William K. Warren Foundation.

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