Hermann Rorschach’s inkblot experiment is celebrating its 100th birthday. In this essay, I look at some perspectives on the Rorschach as an instrument in close alignment with the practice of ...psychodynamic psychotherapy. I bring up the very particular nature of the Rorschach stimulus and the task I mention is the growing tradition of using the test for therapeutic purposes in therapeutic and collaborative assessments, and I speak of the test as a tool for planning and prognostic evaluation in psychotherapy. With the scientific standing that the test has acquired in the last few decades and the high degree of clinical relevance, in particular for the psychodynamically informed practitioner, then the next one hundred years look very promising indeed.
Celotno besedilo
Dostopno za:
BFBNIB, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
ObjectivesTo describe the prevalence and sources of experienced moral stress and anxiety by Swedish frontline healthcare staff in the early phase of COVID-19.DesignCross-sectional survey, ...quantitative and qualitative.Participants and setting1074 healthcare professionals (75% nurses) in intensive, ward-based, primary and municipal care in one Swedish county.MeasuresA study-specific closed-ended and an open-ended questionnaire about moral stress and the Generalised Anxiety Disorder 7-item scale measuring anxiety, followed by an open question about anxiety.FindingsMoral stress was experienced by 52% of respondents and anxiety by 40%. Moral stress in concern for others attributed to institutional constraints comprised experiences of being deprived of possibilities to respond to humane and professional responsibility. Staff experienced being restricted in fulfilling patients’ and families’ need for closeness and security as well as being compelled to provide substandard and inhumane care. Uncertainty about right and good, without blame, was also described. However, a burdensome guilt also emerged as a moral distress, blaming oneself. This comprised feeling complicit in the spread of COVID-19, inadequacy in care and carrying patients’ suffering. Staff also experienced an exhausting distress as a self-concern in an uncontrollable work situation. This comprised a taxing insecurity by being in limbo, being alone and fear of failing, despair of being deprived control by not being heard; unable to influence; distrusting management; as well as an excessive workload.ConclusionsWe have not only contributed with knowledge about experiences of being in the frontline of COVID-19, but also with an understanding of a demarcation between moral stress/distress as a concern for patients and family, and exhausting distress in work situation as self-concern. A lesson for management is that ethics support should first include acknowledgement of self-concern and mitigation of guilt before any structured ethical reflection. Preventive measures for major events should focus on connectedness between all parties concerned, preventing inhumane care and burn-out.
Retrograde amnesia is the inability to recollect memories from a certain period. In the following case study, a patient was assessed with the Zulliger inkblot test in an initial assessment before ...psychotherapy. At termination of the psychotherapy, 42 months later, the test was readministered. At this point, the patient had no recollection of having taken the test before, due to retrograde amnesia following electroconvulsive treatment that was given some time before the initial assessment. This situation offers a unique opportunity to study changes in test results after psychotherapy, without the memory effects of normal recollection of the initial testing. On the surface, many responses shared a striking similarity in content and wording. The structural data from coding of the test results, however, indicated important changes. These changes are discussed and elaborated in relation to the changes observed in the psychotherapeutic treatment.
The aim was to examine the psychometric properties of the Hospital Anxiety and Depression Scale (HADS) in cohorts of working age stroke survivors, before and after inpatient rehabilitation. Stroke ...patients aged 18-66 years registered in the national quality register WebRehab Sweden were included in the study at hospital admission (n = 256), discharge (n = 223), and 1-year follow-up (n = 313). Classical and modern (Rasch) methods were used for psychometric evaluation. The two-factor HADS model measuring anxiety and depression showed better fit than a single factor measuring emotional distress. The instrument's psychometric stability before and after rehabilitation was satisfactory. The anxiety scale showed good psychometric properties, except for item 7, which is not anxiety-specific. Some concerns were observed for the depression items showing weaker discriminant validity, and item 8 performing poorly as a measure of depression. Cronbach's alpha and McDonald's omega coefficients showed satisfactory internal consistency reliability, whereas Rasch person reliability coefficients indicated weaker reliability, especially for the depression scale. Effect size of change between hospital admission and discharge showed a reduction in anxiety and depression symptoms. HADS showed a stable two-factor structure over the rehabilitation period. Patients' perception of items was not affected by the recovery, allowing relevant comparison of HADS scores between different phases of the rehabilitation process. Measures of responsiveness suggest that HADS is sensitive to capturing improvements in emotional distress following rehabilitation interventions. Overall, despite minor psychometric weaknesses, HADS is a suitable instrument for assessing anxiety and depresssion symptoms in stroke patients aged 18-66 years.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
BACKGROUND:Endobiliary drainage for malignant obstructive jaundice presents a viable palliative alternative. Its role and efficacy depend on factors related to the stent, procedure, and patient.
...GOALS:To review the evidence in the literature in which settings plastic or metal stents are cost-effective, and whether adjuvant measures or patient-related factors affect duration of stent patency.
STUDY:Using databases a literature search was performed for papers published from 1979 to April 2004. All retrieved papers reporting experimental or clinical observations were rated according to strength of evidence, and carefully analyzed.
RESULTS AND CONCLUSIONS:Metal stents (Wallstent) stay patent longer than plastic stents (large-bore polyethylene with side-holes), overall median 250 and 110 days, respectively, and seem cost-effective in patients with longer than about 6 months survival, which cannot be accurately predicted. Antibiotics or choleretic agents do not prolong stent patency in clinical settings. In case of stent occlusion, indicated stent exchanges and insertion of a plastic stent, respectively, seem cost-effective in patients initially treated with plastic and metal stents.
The objective of this study was to study the influence on patients’ features and the effect on early outcome of the presence of bile duct stones and endoscopic sphincterotomy (EST), respectively, in ...the presence of edematous gallstone pancreatitis
(GSP). It was a retrospective review of a patient series from 1981 through 1992 at a university teaching hospital. Altogether 96 patients aged 42 to 93 years (median 74 years) with edematous GSP were investigated by endoscopic retrograde cholangiography (ERC) in our department, 75 of whom underwent ERC at first admission. A total of 49 patients (group 1) had common bile duct (CBD) stones, and in 47 (group
2) no CBD stones were found. All patients in group 1 and 15 in group 2 underwent EST; 57 of the 75 patients had EST at first admission. The main outcome measures were pancreas‐related complications and the length of the hospital stay. The early major complication and stone clearance rates of the EST procedure were 3.2% and 96%, respectively. Duration of symptoms prior to ERC was similar in groups 1 and 2 (median
5 and 8 days, respectively). Serum amylase activity was higher in group
2 patients than in group 1 patients 21–258 (median 75) μkat/L vs.
10–328 (median 48) μkat/L (p= 0.01), but the length of hospital stay was similar: 4–39 (median 11) days vs. 4–19
(median 9) days (p= 0.05). Cholangitis at acute admission was more common in group 1 than in group 2 patients (31% vs.
7%; p= 0.02), whereas a history of pancreatitis was noted more often in group 2 patients (49% vs. 8%; p< 0.001). ERC was done 1 to 18 days (median 2 days) and 1–16 days
(median 5 days) (p= 0.02) after admission in groups 1 and 2 respectively, because of the more frequent cholangitis symptoms in group 1. It was concluded that the history and features at admission differed between patients with and without CBD stones at ERC done during an attack of GSP. Early EST had no influence on outcome or hospitalization. This study does not support routine EST in conjunction with mild GSP.RID="" ID="" Correspondence to: L.‐E. Hammarström, M.D., Ph.D., Department of Surgery, Mälarsjukhuset, S‐631 88 Eskilstuna, Sweden
Endoscopic biliary drainage for malignant obstructive jaundice is a viable palliative alternative, but its role and cost-effectiveness compared to percutaneous drainage or surgical bypass are subject ...to debate.
To review the evidence in the literature with regard to the settings in which endoscopic drainage favorably compares with and affords palliation and quality of life comparable to percutaneous drainage or surgical bypass in malignant obstructive jaundice patients.
Using PubMed, Embase, Current Contents, and Medline, a literature search was performed for papers published from 1979 to April 2004. All retrieved papers comparing endoscopic drainage with percutaneous or surgical drainage, with special reference to the level of obstruction, were rated according to the strength of evidence and carefully analyzed.
Palliative drainage affords improved quality of life. The outcome of endoscopic and percutaneous drainage was similar, but data were few and inconsistent. Due to fewer late complications, surgical bypass is an alternative to metal stents (Wallstenttrade mark) which remain patent longer than plastic stents (large-bore polyethylene), with an overall median of 180 and 109 days, respectively, in patients who survive longer than about 6 months, which cannot be accurately predicted though. Overall early and late morbidity, stent patency, and survival were similar in patients treated for hilar compared to distal obstruction.
