Termination of psychotherapy: The journey of ten psychoanalytic and psychodynamic therapists

Objectives: Literature on termination originates mainly from clinical and theoretical accounts as well as practitioners' autobiographical reports. There is, however, a paucity of psychological research on termination, and studies of therapists' experiences are particularly rare. The purpose of this study is to examine the process of termination of therapy based on therapists' narratives of experiences of endings with patients. Design: Grounded Theory methodology has been applied in this study in order to conceptualise the process of termination from the therapist’s perspective. Methods: Ten psychoanalytic and psychodynamic therapists were interviewed for this study. Results: Grounded Theory analysis of the data revealed five central categories: therapist as a person, therapist's awareness of termination, development of therapeutic relationship, working through termination, and the aftermath (post-termination phase). Conclusions: The results offer a Grounded Theory model of the therapist's journey through termination of therapy with patients. Subcategories and their relationships will be explored. Implications for clinical practice, limitations and suggestions for further research will be discussed

The Role of Intensive Insulin Therapy on Superoxide Dismutase (Sod), Tumor Necrosis Factor-? (Tnf-?), and Interleukin-6 (Il-6) on Hyperglycemia in Critically Ill Patients

Hyperglycemia and insulin resistance are common in critically ill patientsin the ICU, although they have not previously had diabetes. It has been reportedthat pronounced hyperglycemia may lead to complications in such patients, andcause the reactive oxygen species (ROS) production, although controlled trial dataare still lacking. The current debatable issue, focusing on whether the intensiveinsulin therapy, aimed at normalizing blood glucose, may improvepatients'prognosis. Then, the debate is mainly about the time to start the therapy,and target of blood glucose level. Therefore, this research is mainly designed andaimed at knowing the difference between intensive insulin therapy andconventional insulin therapy on the increase of superoxide dismutase (SOD),decrease of cytokine production (TNF-? and IL-6), increase of albumin level, andevent of SIRSThis study was carried out in a randomly pre and post-test control groupdesign, involving 40 adult patients being nursed through the ICU Sanglah hospitalDenpasar. They were randomly assigned to receive intensive insulin therapy, inwhich blood glucose was decreased and maintained at the level between 80-110mg/dl, or conventional insulin therapy in which the insulin was infused only if theblood glucose level exceeded 215 mg/dl, decreased and maintained then at thelevel between 180-200 mg/dl.The result of the study showed that there was (1) significant increase ofSOD mean level (370. 70 vs 98.50 U/gHb, p=0.001); (2) no significant decreaseof TNF-? mean level; (3) significant decrease of IL-6 mean level (10.26 vs 2.25;p=0.023); (4) significant increase of albumin mean level ( 0.62 vs 0.22); (5)significant decrease of SIRS (10 % vs 40 %, p=0.000) on intensive insulin therapygroup compared to conventional insulin therapy group. It can be concluded thatintensive insulin therapy could maintain blood glucose level between 80 – 110mg/dl, increase SOD level, decrease IL-6 level, increase albumin level, anddecrease SIRS on hyperglycemia in critically ill ICU patients

Evaluating Patient Preferences of Maintenance Therapy for the Treatment of Chronic Obstructive Pulmonary Disease: A Discrete Choice Experiment in the UK, USA and Germany.

Introduction: With increasing availability of different treatments for chronic obstructive pulmonary disease (COPD), we sought to understand patient preferences for COPD treatment in the UK, USA, and Germany using a discrete choice experiment (DCE). Methods: Qualitative research identified six attributes associated with COPD maintenance treatments: ease of inhaler use, exacerbation frequency, frequency of inhaler use, number of different inhalers used, side effect frequency, and out-of-pocket costs. A DCE using these attributes, with three levels each, was designed and tested through cognitive interviews and piloting. It comprised 18 choice sets, selected using a D-efficient experimental design. Demographics and disease history were collected and the final DCE survey was completed online by participants recruited from panels in the UK, USA and Germany. Responses were analyzed using mixed logit models, with results expressed as odds ratios (ORs). Results: Overall, 450 participants (150 per country) completed the DCE; most (UK and Germany, 97.3%; USA, 98.0%) were included in the final analysis. Based on relative attribute importance, avoidance of side effects was found to be most important (UK: OR 11.65; USA: OR 7.17; Germany: OR 11.45; all p<0.0001), followed by the likelihood of fewer exacerbations (UK: OR 2.22; USA: OR 1.63; Germany: OR 2.54; all p<0.0001) and increased ease of use (UK: OR 1.84; USA: OR 1.84; Germany: OR 1.60; all p<0.0001). Number of inhalers, out-of-pocket costs, and frequency of inhaler use were found to be less important. Preferences were relatively consistent across the three countries. All participants required a reduction in exacerbations to accept more frequent inhaler use or use of more inhalers. Conclusion: When selecting COPD treatment, individuals assigned the highest value to the avoidance of side effects, experiencing fewer exacerbations, and ease of inhaler use. Ensuring that patients' preferences are considered may encourage treatment compliance

The Role of Intensive Insulin Therapy on Superoxide Dismutase (Sod), Tumor Necrosis Factor-? (Tnf-?), and Interleukin-6 (Il-6) on Hyperglycemia in Critically Ill Patients

Hyperglycemia and insulin resistance are common in critically ill patientsin the ICU, although they have not previously had diabetes. It has been reportedthat pronounced hyperglycemia may lead to complications in such patients, andcause the reactive oxygen species (ROS) production, although controlled trial dataare still lacking. The current debatable issue, focusing on whether the intensiveinsulin therapy, aimed at normalizing blood glucose, may improvepatients'prognosis. Then, the debate is mainly about the time to start the therapy,and target of blood glucose level. Therefore, this research is mainly designed andaimed at knowing the difference between intensive insulin therapy andconventional insulin therapy on the increase of superoxide dismutase (SOD),decrease of cytokine production (TNF-? and IL-6), increase of albumin level, andevent of SIRSThis study was carried out in a randomly pre and post-test control groupdesign, involving 40 adult patients being nursed through the ICU Sanglah hospitalDenpasar. They were randomly assigned to receive intensive insulin therapy, inwhich blood glucose was decreased and maintained at the level between 80-110mg/dl, or conventional insulin therapy in which the insulin was infused only if theblood glucose level exceeded 215 mg/dl, decreased and maintained then at thelevel between 180-200 mg/dl.The result of the study showed that there was (1) significant increase ofSOD mean level (370. 70 vs 98.50 U/gHb, p=0.001); (2) no significant decreaseof TNF-? mean level; (3) significant decrease of IL-6 mean level (10.26 vs 2.25;p=0.023); (4) significant increase of albumin mean level ( 0.62 vs 0.22); (5)significant decrease of SIRS (10 % vs 40 %, p=0.000) on intensive insulin therapygroup compared to conventional insulin therapy group. It can be concluded thatintensive insulin therapy could maintain blood glucose level between 80 – 110mg/dl, increase SOD level, decrease IL-6 level, increase albumin level, anddecrease SIRS on hyperglycemia in critically ill ICU patients

Radiation Therapy Medical Physics Review – Delivery, Interactions, Safety, Feasibility, and Head to Head Comparisons of the Leading Radiation Therapy Techniques

Radiation therapy uses high energy radiation to kill cancer cells. Radiation therapy for cancer treatment can take the form of photon therapy (using x-rays and gamma rays), or charged particle therapy including proton therapy and electron therapy. Within these categories, numerous methods of delivery have been developed. For example, a certain type of radiation can be administered by a machine outside of the body, called external-beam radiation therapy, or by a “seed” placed inside of the body near cancer cells, called internal radiation therapy or brachytherapy. Approximately half of all cancer patients receive radiation therapy, and the form of radiation treatment depends on the type of tumor, location of the tumor, available resources, and characteristics of the individual receiving treatment. In the current paper, we discuss and review the various forms of radiation therapy, the physics behind these treatments, the effectiveness of each treatment type compared with the others, the latest research on radiation therapy treatment, and future research directions. We found that proton therapy is the most promising and effective form of radiation therapy, with photon methods such as intensity modulated radiation therapy, 3D-conformal radiation therapy, image guided radiation therapy, and volumetric modulated radiation therapy also showing very good comparative performance

Mapping Occupational Therapy Practice with Postsecondary Students: A Scoping Review

Background: Legislation supports a role for occupational therapy in postsecondary settings, but this area is not a common practice area and the practice area is not well understood. This scoping review maps current literature of occupational therapists working with students in postsecondary settings in order to inform future research and practice. Method: After identifying included articles, a narrative description of the quantitative studies along with a concept map were completed. A qualitative thematic analysis of the articles was also conducted. Results: Twenty-five articles met the inclusion criteria. Quantitative results describe occupational therapy services as both a direct and indirect service provided through offices of disability services, assistive technology, and supported education programs, among others. The primary population with whom occupational therapists engage with are students with mental illness. Three qualitative themes emerged from the scoping review, including the focus on occupation and skills needed for success, using the campus environment, and campus collaboration. Conclusion: The structure of occupational therapy services varies from location to location and occupational therapists work with various populations of students. Future research needs to support the distinct value of occupational therapy in this practice area, including the scope and outcomes of occupational therapy services with different populations of students

The Influence of Lavender Aroma Therapy on Decreasing Blood Pressure in Hypertension Patients

The objective of this research was to determine the influence of lavender aromatherapy on decreasing blood pressure in hypertension patients. The research employed quantitative method with quasi experiment design. The samples were 32 patients either in the treatment group or in the non-treatment group. They were selected by consecutive sampling technique. The result of the research showed that the decrease in systolic and diastolic blood pressure of the treatment group was 9.7299 mmHg and 4.3237 mmHg while without treatment was 7.0461 mmHg and 3.51152 mmHg. Paired t-test resulted the probability value of systolic blood pressure was α (0.000) &lt;0.05, the probability of diastolic blood pressure was α (0.000) &lt;0.05. It could be concluded that there was the influence of lavender aromatherapy on the decrease in systolic and diastolic blood pressure. Inhalation with lavender aromatherapy method can become one of the considerations in nursing intervention to decrease blood pressure in hypertension patients. It can be an alternative of therapy complement besides medication

Aversion Therapy

Excerpt: Aversion therapy uses a number of techniques and stimuli to weaken or eliminate undesirable responses such as deviant sexual behavior and substance abuse. In theory punishment is used to directly reduce the frequency of undesired behaviors through contingent presentation or removal of a stimulus, while aversion, or aversive counter-conditioning, seeks to change the undesirable response indirectly by altering the functions of the discriminative and reinforcing stimuli. In practice this distinction is somewhat blurred, since many aversion procedures have both punishing and stimulus-altering effects