Balint Groups as a Driving Force of Ego Development

This paper gives an overview of one of the main components in the process of Balint groups. The paper is based on the authors\u27 research on the work of Balint groups and the study of literature which deals with the development of ego and the role of Balint groups in the development of participants’ ego. This field is of great interest to the Balint movement and education in medicine. The special place in the discussions on the Balint method is given to the issue of benefit and the nature of influence of the Balint groups on participants. The Balint movement is of special interest for Croatia since it was perhaps among the first in the world to introduce Balint seminars as an official part of education of family doctors. The Croatian Society of Balint Groups as early as in 1970\u27s became a part of the International Federation of Balint Groups. Professor Betlheim was Michael Balint\u27s friend and his followers introduced the method not only in medicine but also in other professions: social work, pedagogy, psychology, sociology etc. The Balint’s method is also very interesting and useful to stomatologists, orthopedists and physiotherapists. Croatian dentists joined the Balint Groups in 1983 and orthopaedists in 1987. These were the unique cases in the European context. The Balint groups are very efficient and necessary in the process of strenghtening ego and selfawarness of these professionals. The paper also discusses the increase of the doctor\u27s self-awareness and selfconsciousness during the process of training in the Balint Groups. The Balint Groups only insist on the doctor-patient relationship and do not interfere with the unconscious of the doctor’s preoccupations. The approach of Enid Balint strives to find harmony between the Balint’s approach and the psychoanalytic approach to the object of the research. According to her understanding, the development of the group atmosphere is similar to the one in the family. The authors reach a similar conclusion in their research

Effects of use of riboflavin and ultraviolet light for pathogen inactivation on quality of platelet concentrates

Background/Aim. Pathogen inactivation in blood and blood products is one of the major means to achieve a zero risk blood supply and improve transfusion safety. Riboflavin (vitamin B2) activated by ultraviolet (UV) light, produces active oxygen which damages cell membrane and prevents replication of the carrier of diseases (viruses, bacteria, protozoa) in all blood products. The aim of this study was to establish the influence of the process of pathogens photoinactivation using riboflavin and UV rays on the biochemical and functional characteristics of platelet concentrates prepared from “buffy coat”. Methods. The examination included 80 platelet concentrates prepared from “buffy coat”, which was separated from whole blood donated by voluntary blood donors around 6 hours from the moment of collection. Concentrates were pooled, filtered and separated unton two groups: one consisted of 10 control units and the other of 10 examined units (pooled platelet concentrates). Examined units of the platelets were treated by riboflavin (35 mL) and UV rays (6.24 J/mL, 265-370 nm) on Mirasol aparature (Caridian BCT Biotechnologies, USA) in approximate duration of 6 min. A total of 35 mL of saline solution was added to the control units. The samples for examining were taken from the control and examined units initially (K0, I0), after the addition of saline (K1) and riboflavin (I1), after illumination (I2), first day of storage (K3, I3) and the fifth day of storage (K4, I4). The following parameters were measured: platelet count and platelet yield, residual erythrocyte and leukocyte count, pH, pO2, pCO2 and bacterial contamination. Results. All the measured parameters showed a statistically significant decrease comparing to K0 and I0; all the results of the first day of platelet storage showed statistically significant decrease comparing to K1 and I1, and all the results of the fifth day of platelet storage (K4, I4) showed a statistically significant decrease comparing to K1 and K3 and to I1 and I3. There was no the mentioned difference in the measured parameters between K4 and I4 (the end of storage - the fifth day). All the platelet units were sterile till the seventh day, when the investigation ended. Conclusion. Platelet concentrates inactivated by riboflavin and UV rays (Mirasol PRT sistem, Caridian BCT, USA) keep all the characteristics assessed by the Guide to the preparation, use and quality assurance of blood components (Council of Europe), during the whole storage period (five days). The obtained data were correlated with existing up to date literature and demonstrated that Mirasol treated platelets were safe and could be incorporated effectively in the routine blood bank and transfusion setting

Testing the effectiveness of work in the Balint group in developing empathy and preventing the burnout syndrome of doctors

Ciljevi ovog istraživanja su bili ispitavanje da li je učestvovanje u Balint grupama povezano sa većim stepenom empatije i smanjenjem sindroma sagorevanja lekara, kao i ispitivanje psihometrijskih karakteristika upitnika za empatiju, Interpersonal Reactivity Index (IRI), uključujući lingvističku validaciju i kulturološku adaptaciju srpske verzije upitnika. Metod: Ovo istraživanje je obuhvatilo 210 lekara iz primarne zdravstvene zaštite. Od 210 lekara, 70 je završilo Balint edukaciju u trajanju od minimum godinu dana, dok 140 lekara nije pohađalo pomenutu edukaciju. Za svakog doktora sa završenom Balint edukacijom metodom slučajnog izbora izabrana su po dva lekara koja nisu završila ovu edukaciju, a koja rade u istom domu zdravlja i imaju istu poziciju (lekar opšte medicine ili specijalista). Kriterijumi za isključivanje iz studije za obe grupe lekara su bili sledeći: lekari koji su bili na bolovanju ili odmoru najmanje mesec dana pre prikupljanja podataka, koji su imali prekid u radu duže od jedne godine (usavršavanje u inostranstvu, dugotrajna bolest ili česte promene posla u poslednjih pet godina) i koji su bili izloženi većoj fizičkoj ili psihičkoj traumi van posla (bolest ili smrt u porodici, razvod, itd.). Za potrebe ovog istraživanja, konstruisan je opšti upitnik za ispitanike i korišćena su još dva dodatna upitnika, za ispitivanje empatije-Davisov „indeks interpersonalne reaktivnosti“ (IRI) i Maslach upitnik za procenu sindroma sagorevaja na poslu (MBI). U statističkoj obradi podataka su korišćene metode deskriptivne statistike, Studentov t-test, Pearson-ov hi-kvadrat test, Spearman-ov koeficijent korelacije, metode logističke i ordinalne regresije, Cronbach-ov koeficijent alfa, intraklasni koeficijent korelacije, kao i faktorska analiza. Rezultati: Preko tri četvrtine (82,9%) lekara u našem uzorku je bilo ženskog pola, dok je 17,1% ispitanika pripadao muškom polu. Srednja vrednost godina starosti ispitanika je iznosila 48,3±9,6 i kretala se od 30 do 65 godina. Lekari koji su završili Balint edukaciju su imali značajno veće skorove na subskalama Zauzimanje tuđeg stanovišta, Fantazija i Empatijska brižnost u odnosu na lekare koji je nisu završili, p<0,001. Što se tiče subskale Lična nelagodnost, nije bilo statistički značajne razlike između lekara ove dve grupe, p=0,530...The aim of our study was to examine whether the participation in Balint group is associated with a higher degree of empathy and reduced burnout syndrome amongst primary health care doctors, as well as testing the psychometric characteristics of empathy questionnaire, Interpersonal Reactivity Index (IRI), including the linguistic validation and cultural adaptation of the Serbian version of the questionnaire. Methods: This investigation was conducted on a population of 210 doctors employed in primary health centers in Belgrade. Of 210 doctors, 70 have completed Balint training for a period of at least one year, whereas 140 doctors have never attended this training (Non-Balint group). Each doctor who completed Balint education, was grouped with two other randomly chosen Non-Balint doctors, who worked at the same health center and had the same level of education (general practitioner or specialist). Exclusion criteria for both groups related to doctors on sick leave or holiday absence at least 1 month prior to the data collection period, who have not worked for more than 1 year (prolonged studies abroad, prolonged illness, or various and frequent changes in the workplace over the past 5 years), and with exposure to increased mental or physical trauma outside of work (death or disease in the family, divorce, etc.). For the purposes of this research, a general questionnaire was drafted and two additional questionnaires used, one to test the empathy-Davis' IRI and the other to measure the burnout-Maslach Burnout Inventory (MBI). The statistical analysis used descriptive statistics, Student’s t-test, Pearson's hi-square test, Spearman's correlation coefficient, logistic and ordinal regression methods, Cronbach alpha, intraclass correlation coefficient, and factor analysis. Results: Over three quarters (82.9%) of doctors in our sample were females, while 17.1% thereof were male doctors. The mean age of the respondents was 48.3 ± 9.6 and ranged from 30 to 65 years. Doctors who completed Balint education had significantly higher scores on subscales Perspective Taking, Fantasy and Empathic Concern compared to doctors who did not complete it, p<0.001..

Our first experiences in applying an original method for removal of ABO-isoagglutinins in ABO-incompatible kidney recipients

Background/Aim. Due to improved methods for removal of ABO isoagglutinins and novel immunosuppressive protocols, short and long term outcome in blood group incompatible is similar to blood group compatible kidney transplantation. The aim of this study was to determine the efficacy of our original method for removal of ABO isoagglutinins from the blood in ABO-incompatible kidney allograft recipients. Method. Between 2006 and 2008 twelve patients were transplanted from ABO incompatible living donors. Titers of ABO isoagglutinins were 4-128 (IgG). Immunosuppressive therapy started 14 days before kidney transplantation with rituximab, followed by a triple therapy (prednisone + tacrolimus + mycophenolate mofetil) and the first plasma exchange (PE) procedure, in which one plasma volume was substituted with albumin and saline on day 7 before transplantation. For selective extracorporeal immunoadsorption, the removed plasma was mixed with donor blood type filtered red blood cells, centrifuged and the supernatant separated and preserved. In the next PE procedure, the removed plasma was replaced with immunoadsorbed plasma, and so on. Titers of ABO agglutinins, renal allograft function and survival were followed-up. Results. The pre-transplant treatment consisting of 1-5 PE procedures and immunosuppressive therapy resulted in target ABO agglutinins titers below 4. During a 10-24 month follow-up three patients had an early acute rejection, one patient acute rejection and hemolytic anemia, two patients surgical complications and one of them lost his graft. In the post-transplant period, the titers of ABO antibodies remained below 4. All the patients had stable kidney allograft function with mean serum creatinine ±SD of 129 ± 45 μmol/l at the end of the study. Conclusion. Our method for removal of ABO antibodies was effective in a limited series of patients and short-term follow-up

Balint Groups as a Driving Force of Ego Development

This paper gives an overview of one of the main components in the process of Balint groups. The paper is based on the authors\u27 research on the work of Balint groups and the study of literature which deals with the development of ego and the role of Balint groups in the development of participants’ ego. This field is of great interest to the Balint movement and education in medicine. The special place in the discussions on the Balint method is given to the issue of benefit and the nature of influence of the Balint groups on participants. The Balint movement is of special interest for Croatia since it was perhaps among the first in the world to introduce Balint seminars as an official part of education of family doctors. The Croatian Society of Balint Groups as early as in 1970\u27s became a part of the International Federation of Balint Groups. Professor Betlheim was Michael Balint\u27s friend and his followers introduced the method not only in medicine but also in other professions: social work, pedagogy, psychology, sociology etc. The Balint’s method is also very interesting and useful to stomatologists, orthopedists and physiotherapists. Croatian dentists joined the Balint Groups in 1983 and orthopaedists in 1987. These were the unique cases in the European context. The Balint groups are very efficient and necessary in the process of strenghtening ego and selfawarness of these professionals. The paper also discusses the increase of the doctor\u27s self-awareness and selfconsciousness during the process of training in the Balint Groups. The Balint Groups only insist on the doctor-patient relationship and do not interfere with the unconscious of the doctor’s preoccupations. The approach of Enid Balint strives to find harmony between the Balint’s approach and the psychoanalytic approach to the object of the research. According to her understanding, the development of the group atmosphere is similar to the one in the family. The authors reach a similar conclusion in their research

Csanád Bálint, The Avars, Byzantium and Italy. A Study in Chorology and Cultural History, Varia Archaeologica Hungarica 31, Institute of Archaeology, Research Centre for the Humanities, Hungarian Academy of Sciences, Archaeolingua, Budapest 2019, 372 pp, 82 figs

У новије време објављене су три важне монографије о Аварима на енглеском језику. Поред значајно осавремењеног превода чувене књиге Валтера Пола из 1988. године и рада Георгиоса Кардараса о односима Византије и Авара од 6. до 9. века, који су пре свега историјске синтезе, пажњу привлачи и иновативно осмишљено остварење Чанада Балинта чији приказ следи

THE ROLE OF SOCIAL WORKERS EMPLOYED IN PSYCHIATRIC DEPARTMENTS AND FACTORS AFFECTING THEIR READINESS TO ENGAGE IN SUPERVISION

Rad prikazuje rezultate istraživanja provedenog na uzorku od 23 socijalnih radnika zaposlenih na odjelima psihijatrije u 5 bolnica na području Grada Zagreba. Cilj istraživanja je dobiti uvid u doživljaj vlastitog iskustva rada socijalnih radnika zaposlenih na odjelima psihijatrije te potrebu za supervizijom. Radi se o eksplorativnom kvalitativnom istraživanju. Za potrebe prikupljanja empirijske građe korišten je polustrukturirani intervju, a podaci su podvrgnuti tematskoj analizi. Rezultati pokazuju da svoju profesionalnu ulogu socijalni radnici zaposleni na odjelima psihijatrije opisuju kroz ulogu socijalnih radnika vezanu uz pacijente te u kontaktu s drugim stručnjacima. Kao izazove s kojima se susreću socijalni radnici navode izazove vezane uz djelokrug rada i iz ostvarenog kontakta s pacijentom. Čimbenici koje sudionici navode, a koji utječu na njihovu spremnost na uključivanje u superviziju, odnose se na percipiranu dobit od supervizije, organizacijski okvir supervizije, strukturu i obilježja supervizijske grupe, obilježja supervizora i organizacijske preduvjete. Rezultati istraživanja ukazuju na područja koja mogu dovesti do profesionalnog stresa (npr. nejasno određen djelokrug rada, položaj socijalnih radnika u timu i sl.) te daju smjernice o kojim čimbenicima treba voditi računa vezano za planiranje i organiziranje supervizije socijalnih radnika u zdravstvu.The paper presents the results of the research conducted on a sample of 23 social workers employed in psychiatric departments in 5 hospitals in the City of Zagreb. The aim of the research is to gain insight into the perception of own work experience of social workers employed in psychiatric departments as well as the need for supervision. It is about an explorative qualitative research study. For the purpose of collecting empirical material, a semi-structured interview was used while the data was subjected to a thematic framework analysis. The results show that the social workers employed in psychiatric departments describe their professional role through the role of social workers in relation to patients and in contact with other experts. Challenges encountered by social workers are challenges related to the scope of their work and to the contact they have with patients. The factors mentioned by participants, the ones that affect their readiness to engage in supervision, relate to the perceived benefit of the supervision, the organisational framework of supervision, the structure and characteristics of the supervisory group, the characteristics of the supervisor and the organisational preconditions. The results indicate the areas that can lead to professional stress (e.g. unclear scope of work, the position of social workers in team work, etc.) and provide guidance on which factors should be taken in mind in planning and organising supervision for medical social workers

Patient with advanced prostate cancer: What to do when a patient refuses the recommended therapy?

U članku je prikazan bolesnik s uznapredovalim stadijem karcinoma prostate koji je odbio predloženi način aktivnog onkološkog, a prihvatio samo palijativno liječenje. Radilo se o 77-godišnjem bolesniku s lokalno proširenom i invazivnom (Gleason score 9) bolešću i koštanim metastazama u centralnom skeletu i oba femura. Preporuke urologa o liječenju, orhidektomiji i uzimanju antiandrogena, je odbio, kao i nastojanja obiteljskoga liječnika da ga nagovori. Prihvatiti ili ne prihvatiti bolesnikovu odluku, te razmišljanja je li se moglo učiniti više, dileme su s kojima se susreću liječnici u skrbi za ovakvog ili slične bolesnike. Zakon o zdravstvenoj zaštiti i Kodeks medicinske etike i deontologije nas obvezuju da uvažimo pravo bolesnika na prihvaćanje ili odbijanje predloženog dijagnostičkog ili terapijskog postupka Osim toga, sve je više rasprava u literaturi o učinkovitosti onkološkog liječenja pacijenata koji se nalaze u terminalnoj fazi bolesti i sve više dokaza o pogoršanju kvalitete života, najčešće uzrokovane neželjenim učincima kemoterapije, povećanim brojem hospitalizacija i drugim oblicima agresivnih intervencija u osoba koje primaju palijativnu kemoterapiju. Međutim, bez obzira na racionalnost donesenih odluka, u zdravstvenim radnicima koji rade s ovakvim bolesnicima ostaje „gorak okus“, pod većim su stresom i skloniji razvoju sindroma izgorjelosti na poslu. Stoga bi valjalo razmišljati o potrebi sustavnog ulaganja u pružanje podrške zdravstvenim radnicima koji rade s teškim bolesnicima kroz antistres treninge, odjelne sastanke, vršnjačke skupine ili Balintove grupe.This article describes the case of a patient with metastatic prostate cancer who refused recommended active oncologic treatment. The patient was a 77-year-old man, with advanced local cancer status, very high PSA level and bone metastases, to whom castration and antiadrogen therapy were recommended. In spite of the intention of his family doctor to accept the recommendations, the patient and his family remained persistent. He only accepted a palliative home care. Taking care for this patient was not an easy task for his family doctor because many dilemmas arose; to accept or not his decision, or if the medical decisions were evidence-based , have I done enough for this patient? But, from the rational point of view, family doctors should accept their patients’ decisions, because they are in accordance to the Croatian Law on Patient’s Rights and in accordance to the Doctor\u27s Ethical Code. Moreover, the patient\u27s decision seemed rational from the medical point of view. There is a lot of evidence based (EBM) literature questioning the effectiveness of chemotherapy near the end of life. But, something irrational in family doctor\u27s thoughts and feelings still remains bringing him a certain sort of stress. This was solved through discussion in peer-groups, because other methods do not exist in practice. In conclusion, it could be said that this situation is very common in health care and that further resources, human and material, should be invested in helping the health care professional to deal with the possibility of the burn-out syndrome

USE OF BLOOD PRODUCTS IN ONCOLOGICAL PATIENTS TREATED WITH RADIO AND CHEMOTHERAPY

Retrospectively, we analyzed the use of blood products in Oncological Clinic of Clinical Center Nis in the period November 1st 2007-November 1st 2008, and also the influence of the treatment on degree of anemia and thrombocytopenia and use of blood products. None of the patients received the whole blood. In this period, 324 patients received the transfusion of blood components, 302 patients received 983 units of red cells (red blood cell concentrate, resuspended, washed, filtered), 17 patients received 5050 ml of platelets (single-donor concentrate or pooled platelet concentrate) and 5 patients received 2200 ml of fresh frozen plasma. An average use of red cell transfusion is 3,26 units, platelet concentrate 5,54, fresh frozen plasma 2 units per oncological patient who receives transfusion. The use of red cell units and platelet concentrate transfusion was adequate (91,85% of patients received transfusion of red cells when Hgb<70g/l, 89,2% of patients received platelet concentrate transfusion when platelet count was less than 20 x109/l). During radio and chemotherapy we noticed a decrease of hematological parameter values, whereas the experimental group patients were dependent on blood product transfusion. Statistically, a significant decrease of hemoglobin level and platelet count was observed in the patients treated only with radiotherapy, who are the greatest consumers of blood products

Mirasol PRT system inactivation efficacy evaluated in platelet concentrates by bacteria-contamination model

Background/Aim. Bacterial contamination of blood components, primarily platelet concentrates (PCs), has been identified as one of the most frequent infectious complications in transfusion practice. PC units have a high risk for bacterial growth/multiplication due to their storage at ambient temperature (20 ± 2°C). Consequences of blood contamination could be effectively prevented or reduced by pathogen inactivation systems. The aim of this study was to determine the Mirasol pathogen reduction technology (PRT) system efficacy in PCs using an artificial bacteria-contamination model. Methods. According to the ABO blood groups, PC units (n = 216) were pooled into 54 pools (PC-Ps). PC-Ps were divided into three equal groups, with 18 units in each, designed for an artificial bacteria-contamination. Briefly, PC-Ps were contaminated by Staphylococcus epidermidis, Staphylococcus aureus or Escherichia coli in concentrations 102 to 107 colony forming units (CFU) per unit. Afterward, PC-Ps were underwent to inactivation by Mirasol PRT system, using UV (l = 265-370 nm) activated riboflavin (RB). All PC-Ps were assayed by BacT/Alert Microbial Detection System for CFU quantification before and after the Mirasol treatment. Samples from non-inactivated PC-P units were tested after preparation and immediately following bacterial contamination. Samples from Mirasol treated units were quantified for CFUs one hour, 3 days and 5 days after inactivation. Results. A complete inactivation of all bacteria species was obtained at CFU concentrations of 102 and 103 per PC-P unit through storage/ investigation period. The most effective inactivation (105 CFU per PC-P unit) was obtained in Escherichia coli setting. Contrary, inactivation of all the three tested bacteria species was unworkable in concentrations of ≥ 106 CFU per PC-P unit. Conclusion. Efficient inactivation of investigated bacteria types with a significant CFU depletion in PC-P units was obtained - 3 Log for all three tested species, and 5 Log for Escherichia coli. The safety of blood component therapy, primarily the clinical use of PCs can be improved using the Mirasol PRT system