Family members’ experiences of “wait and see” as a communication strategy in end-of-life decisions

The aim of this study is to examine family members’ experiences of end-of-life decision-making processes in Norwegian intensive care units (ICUs) to ascertain the degree to which they felt included in the decision-making process and whether they received necessary information. Were they asked about the patient’s preferences, and how did they view their role as family members in the decision-making process? A constructivist interpretive approach to the grounded theory method of qualitative research was employed with interviews of 27 bereaved family members of former ICU patients 3–12 months after the patient’s death. The core finding is that relatives want a more active role in end-of-life decision-making in order to communicate the patient’s wishes. However, many consider their role to be unclear, and few study participants experienced shared decision-making. The clinician’s expression “wait and see” hides and delays the communication of honest and clear information. When physicians finally address their decision, there is no time for family participation. Our results also indicate that nurses should be more involved in family–physician communication. Families are uncertain whether or how they can participate in the decision-making process. They need unambiguous communication and honest information to be able to take part in the decision-making process. We suggest that clinicians in Norwegian ICUs need more training in the knowledge and skills of effective communication with families of dying patients

SOSORT consensus paper: school screening for scoliosis. Where are we today?

This report is the SOSORT Consensus Paper on School Screening for Scoliosis discussed at the 4th International Conference on Conservative Management of Spinal Deformities, presented by SOSORT, on May 2007. The objectives were numerous, 1) the inclusion of the existing information on the issue, 2) the analysis and discussion of the responses by the meeting attendees to the twenty six questions of the questionnaire, 3) the impact of screening on frequency of surgical treatment and of its discontinuation, 4) the reasons why these programs must be continued, 5) the evolving aim of School Screening for Scoliosis and 6) recommendations for improvement of the procedure

Suicidality and Personality Pathology in Adolescence: A Systematic Review

Questo lavoro presenta una rassegna di articoli di ricerca che esaminano il ruolo della patologia di personalità emergente nell'ideazione e nelle condotte suicidarie in adolescenza. inizialmente sono stati selezionati 226 studi in linea con le linee guida PRISMA e sono sati alla fine inclusi in questa rassegna 33 articoli. I dati mostrano che nei pazienti con tentativo di suicidio le percentuali di ciascun disturbo di personalità variano tra il 19,5% e il 22,8%, mentre negli studi autoptici il tasso di diagnosi di un disturbo di personalità varia tra il 29,6% e il 42,1%. La grande maggioranza degli studi si concentra sul ruolo del disturbo borderline di personalità (DBP) per le condotte suicidari, evidenziando anche l suo ruolo predittivo a livello longitudinale. Inoltre, la rassegna di letteratura mostra che i tratti di personalità che si ritiene sottendano il DBP , quali l'instabilità affettiva, l'impulsività, la diffusone di identità hanno dei nessi predittivi specifici con le condotte suicidarie. Altre dimensioni patologiche di personalità come l'aggressività, il sadismo e il perfezionismo associate con altri disturbi di personalità, cioè il narcisistico e l'antisociale, hanno anch'essi mostrato un significativo ruolo di mediazione per il rischio suicidario. Nel complesso, questi risultati sembrano avere un parallelo con il ruolo predittivo della patologia di personalità per la sucidiarietà negli adulti e indicano la rilevanza della valutazione della presenza di pattern emergenti dei disturbi di personalità per la gestione clinica del rischio suicidario n adolescenza.This work presents a review of research papers examining the role of emerging personality pathology in suicidal ideation and behaviours in adolescence. Initially, 226 studies were selected in line with PRISMA guidelines, and 33 articles were finally included in this review. The data show percentages of any personality disorder diagnosis ranging from 19.5 to 22.8% in suicide attempters, while in autopsy studies, the rate of personality disorder diagnosis varied between 29.6 and 42.1%. The overwhelming majority of the studies focus on the role of borderline personality disorder (BPD) in suicidal behaviours, also highlighting its predictive role at a longitudinal level. Furthermore, the literature review shows that personality traits supposed to underlie BPD, such as affective instability, impulsivity and identity diffusion, have specific predictive links with suicidal conduct. Other personality pathology dimensions, such as aggressiveness, sadism and perfectionism that are associated with other personality disorders, namely, antisocial and narcissistic personality disorders, have also shown a significant mediating role for suicidal risk. Overall, these results seem to parallel the role of personality pathology in predicting suicide in adulthood and point to the relevance of assessing the presence of emerging patterns of personality disorders for the clinical management of suicidal risk in adolescence

The road from pathological narcissism to suicidality in adolescence: an empirical study

La ricerca clinica ed empirica ha evidenziato un nesso complesso fra il narcisismo patologico e il processo suicidario in età adulta. Data la rilevanza della sucidarietà e delle peculiari vicissitudini narcisistiche per l'adolescenza, la ricerca si propone di investigare la relazione fra narcisismo patologico nella una prospettiva multi-dimensionale dell'Intervista Diagnostica per il Narcisismo (DIN) and l'ideazione e le condotte suicidarie in un campione di adolescenti italiani. Metodi: a103 adolescenti italiani maschi e femmine fra i 12 e i 18 anni sono stati somministrati la DIN, la SCID II, CSSRS e la Kiddie-SADS con un follow-up a sei mesi. Risultati: le correlazioni il t-test e le analisi di regressione multipla hanno evidenziato l'associazione degli stati affettivi e dell'umore narcisistici sia con l'ideazione che con la letalità delle condotte. L'incremento nella dimensione della grandiosità è associata al passaggio a gesti suicidari ad elevata letalità potenziale. Conclusioni: l'ideazione e le condotte suicidarie sembrano assolvere alla funzione di restaurazione del senso di controllo e dell'autostima negli individui narcisistici che sperimentano uno stato di disregolazione affettiva. Il funzionamento narcisistico patologico sembra giocare un ruolo importante nel processo sucidario adolescenziale esattamente come in età adulta. L'assessment del funzionamento narcisistico adolescenziale può fornire delle utili indicazioni nella comprensione e gestione del rischio suicidario in questa fase di vita.Background: Clinical and empirical research evidenced a complex link between pathological narcissism and the suicidal process in adulthood. Given the relevance of suicidality and the peculiar narcissistic vicissitudes of adolescence, the proposed research investigated the relationship between pathological narcissism analyzed from the multi-dimensional perspective of the Diagnostic Interview for Narcissism (DIN) and suicidal ideation conducted in a sample of Italian Adolescents. Methods: One hundred and three Italian male and female adolescents between 12 and 18 were administered the DIN, SCIDII, CSSRS, and Kiddie-SADS with six months follow-up. Results: The correlation, t-test, multiple regression analyses evidenced the association of narcissistic affective states and mood with both suicidal ideation and lethality of conduct. The increase in the dimension of grandiosity is associated with the passage to potentially highly lethal suicidal gestures. Conclu-sions: Suicidal ideation and conduct seem to serve the function of restoring a sense of control and self-esteem in narcissistic individuals experiencing a state of affective dysregulation. Narcissistic pathological functioning seems to play an important role in the adolescent suicidal process, quite like adulthood. Assessing an adolescent’s narcissistic functioning may provide useful clinical information in understanding and managing the suicidal risk in this phase of life

Study of the Heat-Treatments Effect on High Strength Ductile Cast Iron Welded Joints

Nowadays, ultimate tensile strengths above 400 MPa become usual for ductile irons, thus allowing the implementation of new design paradigms. Large concentrations of carbon and other influencing elements can negatively interfere with the welding process of ductile cast irons. Efforts made by researchers have led to the discovery of solutions which enable good enough operational results to consider welding as a viable repairing or joining method. Although these alloys have been available for quite some time, researchers have mainly focused on issues relating to microstructural phenomena tied to casting and similar processes, leaving much to explore in terms of their weldability. Thus, this work intends to investigate the effect of different heat-treatments on the weldability of a high strength ductile cast iron by assessing the mechanical properties of welded joints as well as structural modifications induced by thermal cycles imposed before and after welding. Successful weld joints were achieved showing a clear heat affected zone (HAZ) close to the joint area. This area is coincident with the fracture area of the welded samples when loaded on a tensile test bench, having obtained promising results regarding mechanical strength and strain. The hardness of the welded zone was also carefully investigated, showing clear changes throughout the joint

Comparing the Structure and Mechanical Properties of Welds on Ductile Cast Iron (700 MPa) under Different Heat Treatment Conditions

The weldability of ductile iron, as widely known, is relatively poor, essentially due to its typical carbon equivalent value. The present study was developed surrounding the heat treatability of welded joints made with a high strength ductile cast iron detaining an ultimate tensile strength of 700 MPa, and aims to determine which heat treatment procedures promote the best results, in terms of microstructure and mechanical properties. These types of alloys are suitable for the automotive industry, as they allow engineers to reduce the thickness of parts while maintaining mechanical strength, decreasing the global weight of vehicles and providing a path for more sustainable development. The results allow us to conclude that heat treatment methodology has a large impact on the mechanical properties of welded joints created from the study material. However, the thermal cycles suffered during welding promote the formation of ledeburite areas near the weld joint. This situation could possibly be dealt through the implementation of post-welding heat treatments (PWHT) with specific parameters. In contrast to a ductile cast iron tested in a previous work, the bull-eye ductile cast iron with 700 MPa ultimate tensile strength presented better results during the post-welding heat treatment than during preheating