Stories of courage in a group of adults with Substance Use Disorder

The treatment for drug addiction is considered a difficult path for the most of patients. As matter of fact, individuals with Substance Use Disorder (SUD) experience numerous challenges before, during and after the treatment (e.g. tackling an unpredictable, uncertain and paradoxically negative future, tackling the anxiety and anticipatory fear of physical pain associated with abstinence; decide to go beyond self-justification and self-deception). Courage could be considered a positive and functional resource to help people with SUD to face challenges and difficulties related to treatment. In connection therewith, the aim of this study was to examine, using an embedded mix method analysis, the personal stories of courage of 80 individuals with SUD in order to identify the themes and types of courage used in their life. The analysis carried out showed that individuals with SUD reported more frequently stories of courage related to their SUD condition respect to other life situation. Moreover, the quantitative analysis showed that participants used more frequently psychological courage respect to moral and physical courage when these stories were referred to their SUD condition then other life situations

Substance Use Disorder and Future Life Prospective

The aim of this research project is to provide a better understanding of the mechanisms involved in the promotion of life satisfaction in adults with Substance Use Disorder (SUD). Life satisfaction can be considered an important diagnostic and outcome criterion in substance use disorder issues but also in vocational rehabilitation issues (Assari & Jafari, 2010; Laudet, Morgen, & White, 2006; Smith & Larson, 2003; Rudolf & Watts, 2002; Savickas et al., 2009). The treatment aims to reach patients’ recovery, which is defined as abstinence plus improved life satisfaction (Laudet, 2011). Moreover, to have a satisfying future life, it is also the principal future goal of people with SUD (e.g., Laudet, Savage, & Mahmood, 2002; Laudet, Morgen, & White, 2006). However, re-designing, and getting positive future scenarios after treatment is not always easy for people with SUD because of the many barriers that they can experience, such as barriers at level of client (for example, the lack of work’s experiences, unrealistic career goals, low levels of self-esteem, low problem-solving skills) of program (for example, rigidity of treatment) and of social context (prejudice against drug users, problems of the labor market, economic crisis) (Earnshaw, Smith, Chaudoir, Amico, & Copenhaver, 2013; European Observatory on Drugs, 2013; Graham, 2006; Richardson, Wood, Montaner, & Kerr, 2012; Sgaramella, Ferrari, & Ginevra, 2015). Considering this, vocational rehabilitation interventions have a crucial role to help people with Substance Use Disorder to design a new and satisfying life. For this reason, and based on the Life Design paradigm that can be considered a career and vocational parading for all people with and without a specific vulnerability or disorder, the role of career adaptability, hope, courage on life satisfaction was investigated in adults with and without SUD. With this aim, two studies were carried out. In the first study, the attention was focused on career adaptability and hope and their relationship with life satisfaction in individuals with SUD. More specifically, based on Porfeli and Savickas’s suggestions (2012) and based on Rudolph, Lavigne, and Zacher’s (2017) meta-analysis and Santilli, Nota, Ginevra, and Soresi’s study (2014) using a multi-group method, the mediating role of hope on the relationship between career adaptability and life satisfaction in a group of individuals with SUD was tested and simultaneously the invariance of this model across individuals with and without SUD was verified. The results obtained showed that despite adults with SUD have lower levels of carer adaptability, hope and life satisfaction in respect to adults without SUD, the mediation model tested was invariant in adults with and without SUD. In the second study, attention was focused on courage. Specifically, based on Peterson, Ruch, Beermann, Park, & Seligman’ study (2007), the predictive role of courage on life satisfaction was tested, using a multivariate regression analysis, beyond the addiction condition. The analysis carried out showed that courage predicts in positive ways life satisfaction beyond the addiction variable and other control variables such as “age” and “years of education”. These results are in line with Seligman and colleagues (Seligman, 2002; Seligman & Csikszentmihalyi, 2014; Savickas et al., 2009) that affirm the need to bring the building of strength to the forefront in the treatment of mental illness and in vocational programs. Additionally, personal stories of courage reported by a group of individuals with SUD were analyzed in order to identify themes, meanings, and types of courage performed. The qualitative and quantitative analysis carried out showed that individuals with SUD described more frequently courageous behaviors in overcoming psychological risks than physical and moral risks, especially when these stories were referred to the addiction rather than to other life situations. These results were in line with Putman’s assumptions (2004; 2010). More specifically, for Putman, taking on addiction requires more psychological courage in respect to moral and physical courage, in particular to face challenges related to their past experiences and choices but also to face challenges related to personal and professional future planning. The main theoretical implication of this research project was to study the positive and predictive role of relevant constructs in vocational rehabilitation intervention such as career adaptability, hope, courage on life satisfaction, for the first time, in adults with SUD. Considering that life satisfaction is believed to be an important diagnostic and outcome criteria in substance use disorder issues (Assari, & Jafari, 2010; Laudet et al., 2006; Rudolf & Watts, 2002; Smith & Larson, 2003), it is possible to hypothesize that the results obtained in this research project can provide a main theoretical implication in substance use disorder issues. As regards the applicative implication, this research project provide useful information to plain intervention to increases life satisfaction and core ability for future life designing in people with SUD

Life Design for an Inclusive and Sustainable Future

Societies today are highly complex and often impacted by uncertainty, rapid change, globalization, and inequality, all of which have significant impact on the wellbeing of people. These changes make it more difficult not only for a great part of the population to live in the present, but also for succeeding generations to aspire to and imagine a possible future. Considering this, career guidance needs a change of pace that can only be associated with investments in inclusion and sustainability. In this chapter we provide a brief historical excursion through the social role that career guidance has played through the years, and then outline possible actions that career guidance professionals could take so as to embrace, sustain, and foster the creation of a better future for everyone and to contribute to the creation of inclusive and sustainable societies.

Comorbidities and disease severity as risk factors for carbapenem-resistant Klebsiella pneumoniae colonization: report of an experience in an internal medicine unit

Carbapenem-resistant Klebsiella pneumoniae (CRKP) is an emerging multidrug-resistant nosocomial pathogen, spreading to hospitalized elderly patients. Risk factors in this setting are unclear. Our aims were to explore the contribution of multi-morbidity and disease severity in the onset of CRKP colonization/infection, and to describe changes in epidemiology after the institution of quarantine-ward managed by staff-cohorting

The accuracy of burn depth diagnosis: Clinical assessment before and after enzymatic debridement

Abstract Introduction The most common technique used to determine burn depth is clinical assessment by experienced burn surgeons, although this has been shown to be reliable in only 60–75% of the cases. Overestimation of burn depth may result in needles surgery, while burn depth underestimation can led to an increased length of stay in the hospital, risk of contracture and hypertrophic scar formation. The aim of this study was to assess the clinical evaluation of burn depth before and after enzymatic debridement with Nexobrid®. Methods The study model was retrospective. 69 patient records were collected at our burn units, from Jan 2018 to Jan 2019. Each target wound was directly assessed by a single expert physician before and after enzymatic debridement. It was investigated whether the expert, by single wound, would have indicated the need for skin grafts before treatment with Nexobrid® and after treatment. Results Prior to treatment with Nexobrid®, the expert physician assessed that a graft was necessary for 47/69 patients (68.1%). Following debridement, the same expert deemed that the patients needing a graft were 19/69 (27.5%); analysing K-agreement, a 40.6% discrepancy between the pre and post-treatment opinion with Nexobrid® was observed. Discussion The use of Nexobrid® enzymatic debridement can positively affect burn depth clinical assessment, increasing its specificity and sensitivity, without any need for delay. This can lead to a significant change in clinical practice, minimizing the use of surgery, therefore increasing quality and precision of the reconstructive phase

Changes of Oxytocin and Serotonin Values in Dialysis Patients after Animal Assisted Activities (AAAs) with a Dog-A Preliminary Study

Simple Summary This study aimed to improve the moment of dialysis because the emotional management of a person during treatment can help to reduce stress, anxiety and depression. This process positively affects the acceptance and progress of treatment and improves the self-management of the disease, a very important achievement in chronic kidney disease. Serotonin and oxytocin are important neuromodulators of different human behaviours, such as affectivity and socialization, and are involved in the control of stress, anxiety and social cooperation. The relationship between humans and domestic animals provides psychophysical well-being and can facilitate interpersonal bonds by favouring mechanisms involved in social relations. Dogs due to their ethological characteristics, allow the establishment of an active relationship through play, communication and interaction. Animal-assisted activities (AAAs) are structured interventions aimed at improving the psychophysical conditions of people in stressful conditions. Our study was aimed at determining the circulating levels of serotonin and oxytocin in patients who participated in an AAAs program with a dog during dialysis treatment. Our study aimed to measure the levels of serotonin and oxytocin in patients affected by end-stage renal disease (ESRD), undergoing dialysis and participating in a program of animal-assisted activities (AAAs) with a dog. Ten patients with comparable levels of ESRD were enrolled. A blood sample was taken before the start of the study in order to establish basal levels. Eleven meetings were held once a week for 3 months during the last hour of dialysis, and blood samples were collected before and after AAAs. Two more meetings, one month apart from each other, were held two months later without the dog but with the same veterinarian zootherapist. Blood was drawn at the beginning and at the end of each meeting. The samples were then processed for the measurement of serotonin and oxytocin, and data obtained were analysed using analysis of variance with mixed effect models. The results show an increasing level of both serotonin and oxytocin between subsequent meetings with the dog and an increasing trend of inter-intervention levels. Overall, the results suggest that AAAs lead to modifications of serotonin and oxytocin levels, which are also accompanied by behavioural changes of patients

Distinct MRI pattern of "pseudoresponse" in recurrent glioblastoma multiforme treated with regorafenib: Case report and literature review

: Antiangiogenic agents can induce a distinct MRI pattern in glioblastoma, characterized by a decrease in the contrast enhancement on T1-weighted images and a simultaneous hyperintensity on T2-weighted or fluid-attenuated inversion recovery images

Rethinking treatment failures. Research on a group of Italian psychotherapists

IntroductionPsychotherapeutic failures involve situational, relational, and personal factors. Dropout refers to a patient’s unilateral termination of treatment without the therapist’s knowledge or approval. Premature termination occurs when therapy is discontinued before achieving a sufficient reduction in initial problems.ObjectiveThis study explores the role of therapist’s emotional response (countertransference), gender, psychotherapeutic orientation, and patient diagnosis in the context of psychotherapeutic failures.MethodA mixed-method approach was used. Fifty-nine Italian psychotherapists, practicing mostly privately with at least 5 years of experience, were recruited through Italian professional internet websites. The Therapist Response Questionnaire and the Impasse Interview were administered to each psychotherapist. Each therapist was asked to reflect on their last dropout patient. Quantitative (MANOVA) and qualitative analyses (textual content analysis) were conducted with SPSS and T-LAB, respectively.ResultsThe quantitative analyses revealed that the most frequent countertransference response was Helpless/Inadequate, with female therapists experiencing this more frequently than male therapists. The qualitative analyses identified two main factors explaining most of the variance in countertransference responses: Parental/Protective versus Hostile/Angry, and Positive/Satisfying versus Helpless/Inadequate, with Helpless/Inadequate central. Additionally, the qualitative analysis of treatment interruption methods revealed two factors explaining over 50% of the variance. Lack of communication was linked to negative themes, while mediated and direct communication were associated with positive terms. Direct communication was characterized as useful, while mediated communication was linked to dropout and attachment figures.ConclusionUnder pressure, psychotherapists’ anxiety levels increase, often managed ambivalently or avoidantly. These results suggest that awareness of psychotherapist emotional responses is important to limit psychotherapeutic failures. These findings offer valuable insights for clinical practice

The association of serum procalcitonin and high-sensitivity C-reactive protein with pneumonia in elderly multimorbid patients with respiratory symptoms: retrospective cohort study

BACKGROUND: Serum procalcitonin and high-sensitivity C-reactive protein (hs-CRP) elevations have been associated with pneumonia in adults. Our aim was to establish their diagnostic usefulness in a cohort of hospitalized multimorbid patients ≥65 years old admitted to hospital with acute respiratory symptoms.METHODS: With a retrospective cohort study design, all multimorbid patients ≥65 years-old with acute respiratory symptoms admitted to an internal medicine hospital ward in Italy from January to August 2013 were evaluated. Pneumonia diagnosis, comorbidities expressed through Cumulative Illness Rating Scale (CIRS), setting of living, length of stay, serum hs-CRP and procalcitonin at admission were collected for each patient. Data were analyzed with Mann-Whitney's U test and multivariate Cox logistic regression analysis. A Receiver Operating Characteristic (ROC) curve was used to verify each biomarker's association with pneumonia diagnosis.RESULTS: Four hundred fifty five patients (227 M) were included in the study, of whom 239 with pneumonia (138 M, mean age 80 ± 13) and 216 without pneumonia (89 M, mean age 80 ± 14). After adjustment for age and sex, median levels of hs-CRP were significantly higher in patients with pneumonia (116 mg/L, IQR 46.5-179.0, vs 22.5 mg/dl, IQR 6.9-84.4, p < 0.0001), while procalcitonin median levels were not (0.22 ng/ml IQR 0.12-0.87, vs 0.15 ng/ml, IQR 0.10-0.35, p = 0.08). The ROC analysis showed that, unlike procalcitonin, hs-CRP values were predictive of pneumonia (AUC 0.76, 95 % CI 0.72-0.79, p < 0.0001, cut-off value 61 mg/L), even after adjustment for possible confounders including nursing home residence and dementia. Serum hs-CRP levels >61 mg/L were independently associated with a 3.59-fold increased risk of pneumonia (OR 3.59, 95 % CI 2.35-5.48, p < 0.0001).CONCLUSION: In elderly multimorbid patients who require hospital admission for respiratory symptoms, serum hs-CRP testing seems to be more useful than procalcitonin for guiding the diagnostic process when clinical suspicion of pneumonia is present. Procalcitonin testing might hence be not recommended in this setting