Good-Enough Therapeutic Space Design: A Literature Review and Considerations for Expressive Arts Therapy

This thesis investigates the role of therapeutic space in expressive arts therapy through an interdisciplinary and international literature review. Definitions of therapeutic space and therapeutic space design are explored. This paper is theoretically grounded in the notion of good-enough therapeutic space, which is adapted from Winnicott’s (as cited in Davis & Wallbridge, 2004/1981) concept of a good-enough holding environment and Moskowitz-Corrois’s (2018) understanding of therapeutic space. Personal internship experiences of not-good-enough therapeutic space and a personal arts-based inquiry conceptualizing good-enough therapeutic space are discussed. Research from non-therapeutic and therapeutic settings, for both general and specific populations, are surveyed. The literature establishes the positive impact that therapeutic space design can have on the therapeutic relationship. A checklist of good-enough therapeutic space design considerations for the expressive arts therapist, inspired by Liddicoat (2018), is drafted and presented. These considerations are accessible, adaptable, and applicable to the expressive arts. The roles of the therapist and client in the design process, limitations of this paper, and directions for further research are identified

Outcome of paediatric supracondylar humeral fractures treated by surgery at the University Teaching Hospital of Kigali, Rwanda

Background: Supracondylar humeral fractures are common elbow injuries in children. When these fractures are managed improperly, patients end up having complications that interfere with daily activities. Objective: This study was conducted to evaluate the functional outcome of supracondylar humeral fractures treated with surgery at the University Teaching Hospital of Kigali, Rwanda. Methodology: This was a combined retrospective and cross-sectional observational study. The sample size was 108. Theatre logs and OPD files were used to obtain patients' clinical information. Functional outcome was evaluated using QuickDASH score. Results: Children having 6 to 10 years of age were predominant (54.6%). Male to female ratio was 1.9:1. The left elbow was most affected (60.2%). Seventy five patients (69.4%) were within normal range, 27 (25.0%) patients had mild disability, 5 (4.7%) patients had moderate disability, and 1 (0.9%) patient had severe disability. There were no patients with very severe disability. The most common complication was elbow stiffness (59.3%), followed by gunstock deformity (27.1%). The only determinant of functional outcome found was the time (within 4 days or beyond) from injury to management (OR: 0.993, 95% CI: {0.987-1.000}, p-value: 0.048). Conclusion: For operable supracondylar humeral fractures in children, operation within 4 days and good follow up of patients in postoperative period are crucial for good functional outcome

POROUS TANTALUM IMPLANTS FOR PRIMARY AND REVISION TUMOUR SURGERY OF THE PELVIS AND LOWER EXTREMITY

POROUS TANTALUM IMPLANTS FOR PRIMARY AND REVISION TUMOUR SURGERY OF THE PELVIS AND LOWER EXTREMIT

Imaging of bone tumours for the musculoskeletal oncology surgeon.

The appropriate diagnosis and treatment of bone tumors requires close collaboration between different medical specialists. Imaging plays a key role throughout the process. Radiographic detection of a bone tumor is usually not challenging. Accurate diagnosis is often possible from physical examination, history, and standard radiographs. The location of the lesion in the bone and the skeleton, its size and margins, the presence and type of periosteal reaction, and any mineralization all help determine diagnosis. Other imaging modalities contribute to the formation of a diagnosis but are more critical for staging, evaluation of response to treatment, surgical planning, and follow-up.When necessary, biopsy is often radioguided, and should be performed in consultation with the surgeon performing the definitive operative procedure. CT is optimal for characterization of the bone involvement and for evaluation of pulmonary metastases. MRI is highly accurate in determining the intraosseous extent of tumor and for assessing soft tissue, joint, and vascular involvement. FDG-PET imaging is becoming increasingly useful for the staging of tumors, assessing response to neoadjuvant treatment, and detecting relapses.Refinement of these and other imaging modalities and the development of new technologies such as image fusion for computer-navigated bone tumor surgery will help surgeons produce a detailed and reliable preoperative plan, especially in challenging sites such as the pelvis and spin

Patients who leave the emergency department without being seen and their follow-up behavior: a retrospective descriptive analysis

Past studies suggest that patients who leave without being seen by a physician (LWBS) from a hospital’s emergency department (ED) represent a quality and safety concern, and thus LWBS rates have often been used as an ED performance metric. There are few recent studies, however, that have examined the characteristics of the LWBS population at hospitals in the United States

Use of Hotels as a Disposition Alternative to Hospital Admission for Undomiciled Patients Undergoing SARS-CoV-2 Testing

Introduction: The coronavirus 2019 (COVID-19) pandemic has presented various unprecedented challenges to healthcare systems globally, prompting society to adopt new preventative strategies to curb spread of the disease. Those experiencing homelessness have been particularly impacted because of barriers to practicing social distancing, inability to isolate, and poor access to care. Project Roomkey was established in California as a statewide measure to provide non-congregate shelter options for individuals experiencing homelessness to properly quarantine. On goal in this study was to analyze the effectiveness of hotel rooms as a safe disposition alternative to hospital admission for patients experiencing homelessness and who were also positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).Methods: This was a retrospective, observational study that included chart review of patients who were discharged to the hotel from March 2020–December 2021. We recorded demographic information, index visit details, number of emergency department (ED) visits both a month prior to and following the index visit, admission rates, and number of deaths.Results: During this 21-month study period, a total of 2,015 patients who identified as undomiciled were tested for SARS-COV-2 in the ED for various reasons. Of those patients, 83 were discharged from the ED to the hotel. Of the 83 patients, 40 (48.2%) ultimately tested positive for SARS-CoV-2 during their index visit. Two patients returned to the ED within seven days with COVID-19-related symptoms, and 10 patients within 30 days. Two patients required subsequent admission with COVID-19 pneumonia. No deaths were recorded within the 30-day follow-up period.Conclusion: The availability of a hotel served as a safe alternative to hospital admission for patients experiencing homelessness and who were either suspected or confirmed to have COVID-19. It is reasonable to consider similar measures in the management of other transmissible diseases for patients experiencing homelessness who require isolation

Imaging of bone tumours for the musculoskeletal oncology surgeon.

The appropriate diagnosis and treatment of bone tumors requires close collaboration between different medical specialists. Imaging plays a key role throughout the process. Radiographic detection of a bone tumor is usually not challenging. Accurate diagnosis is often possible from physical examination, history, and standard radiographs. The location of the lesion in the bone and the skeleton, its size and margins, the presence and type of periosteal reaction, and any mineralization all help determine diagnosis. Other imaging modalities contribute to the formation of a diagnosis but are more critical for staging, evaluation of response to treatment, surgical planning, and follow-up.When necessary, biopsy is often radioguided, and should be performed in consultation with the surgeon performing the definitive operative procedure. CT is optimal for characterization of the bone involvement and for evaluation of pulmonary metastases. MRI is highly accurate in determining the intraosseous extent of tumor and for assessing soft tissue, joint, and vascular involvement. FDG-PET imaging is becoming increasingly useful for the staging of tumors, assessing response to neoadjuvant treatment, and detecting relapses.Refinement of these and other imaging modalities and the development of new technologies such as image fusion for computer-navigated bone tumor surgery will help surgeons produce a detailed and reliable preoperative plan, especially in challenging sites such as the pelvis and spin