Some reflections on Termination: Transference and Countertransference

INTRODUCTION Nearing the completion of my psychiatric residency, I ingenuously told my supervisor that I needed to know the steps of termination in therapy with patients. On the surface, this request reflected an awareness of the issues at hand and their importance. Beneath lay ambivalence and countertransference anxiety . For the graduating resident, time ordinarily invested in thought and study fills with practical considerations of job hunting and starting a practice. The resident\u27 s own unresolved and unsettling separation issues can further push aside therapeutic considerations for his patients. Termination, the art of the veteran therapist, becomes an unwelcome task at this time of professional passage when anything codifying professional identity is sought. In the unfortunate sequence of most residencies, this can be the first experience with forced termination of therapy. Forced termination is also a neglected topic within termination literature: a stepchild absent from standard psychotherapy texts from Colby to Tarachow. Weigert (1) and many others expound a necessary mutuality between patient and the rapist before termination can be set. Any prematurity on the therapist\u27s part, by definition, sets up a forced situation with its concommitant transference reactions and may be initiated by unintentional countertransference reactions. In reference to character analysis, Freud (2) doubted if even deep analysis could prevent a return of neurotic symptoms under the pressures of everyday life. The issue here becomes not whether treatment is terminable; but rather, one of understanding transference and countertransference. Supervision and the resident\u27s own therapy can make difficult terrain into a crucial learning experience. I share my experience with just one patient and my imperfect understanding of a complex interaction, in light of termination literature

Gap junction reduction in cardiomyocytes following transforming growth factor- beta treatment and Trypanosoma cruzi infection

Gap junction connexin-43 (Cx43) molecules are responsible for electrical impulse conduction in the heart and are affected by transforming growth factor-beta (TGF-beta). This cytokine increases during Trypanosoma cruzi infection, modulating fibrosis and the parasite cell cycle. We studied Cx43 expression in cardiomyocytes exposed or not to TGF-beta T. cruzi, or SB-431542, an inhibitor of TGF-beta receptor type I (ALK-5). Cx43 expression was also examined in hearts with dilated cardiopathy from chronic Chagas disease patients, in which TGF-beta signalling had been shown previously to be highly activated. We demonstrated that TGF-beta treatment induced disorganised gap junctions in non-infected cardiomyocytes, leading to a punctate, diffuse and non-uniform Cx43 staining. A similar pattern was detected in T. cruzi-infected cardiomyocytes concomitant with high TGF-beta secretion. Both results were reversed if the cells were incubated with SB-431542. Similar tests were performed using human chronic chagasic patients and we confirmed a down-regulation of Cx43 expression, an altered distribution of plaques in the heart and a significant reduction in the number and length of Cx43 plaques, which correlated negatively with cardiomegaly. We conclude that elevated TGF-beta levels during T. cruzi infection promote heart fibrosis and disorganise gap junctions, possibly contributing to abnormal impulse conduction and arrhythmia that characterise severe cardiopathy in Chagas disease

Climate Change and Resulting Floods: Using Social Capital to Strengthen Community Resilience in Eastwick, Philadelphia a known floodplain

• Climate change will produce intense weather events like increased precipitation and flooding • Based on climate projections, Philadelphia will be hotter and wetter, and will experience more frequent and intense weather events (OOS, 2016) •Floods are the second most common hazards in our city (OEM, 2017) • Vulnerable population such as children, people of color, elderly population and people with disability are severely impacted by climate change Poster presented at AHPA conference in Atlanta Georgia, United States.https://jdc.jefferson.edu/jcphposters/1013/thumbnail.jp

Evaluating the Effectiveness of Using Thiel Soft-Embalmed Donors to Teach the Female Pelvic Exam to Medical Students

At the Quillen College of Medicine, first year medical students are taught how to perform the female pelvic exam as part of the “Introduction to Physical Exam” course. Our previous research has found that students feel more confident and report a higher level of perceived transferability to live patients when learning the pelvic exam on soft-embalmed donors in comparison to low-fidelity mannequins. Our goal in this project was to incorporate soft-embalmed donors into the curriculum of first year medical students, making this teaching method available to all students, and objectively assess their skills as well as their retention. During the “Introduction to Physical Exam” course, high fidelity soft embalmed donors were available for students to practice the female pelvic exam with instruction from attending physicians. After learning exam techniques, all 67 students were given a survey to assess their confidence, perceived transferability, and preference for either soft embalmed donors or mannequins. They were also invited back the following week to assess their short term retention and ability to accurately perform the pelvic exam, with the option of using communication skills learned elsewhere in the ETSU curriculum. Thirteen students returned for this follow-up session and completed surveys to reassess their experience. We plan to follow this cohort of students throughout their medical school career to assess long term retention. All return participants felt they retained the pelvic exam knowledge learned the week prior, with 61.54% agreeing, and 38.46% strongly agreeing. Most felt prepared to now do a pelvic exam on a live patient (53.85% agreed, 38.46% strongly agreed). Students also reported that feedback on their communication and procedural skills was beneficial to the learning process. The use of high fidelity soft embalmed donors in medical education provides students with a realistic model to learn and become confident in performing pelvic exams. We have seen that this education model helps them retain their knowledge on pelvic exam technique. We look forward to following this cohort of students to see if this retention of knowledge persists into their third year of medical school

Effect of Rotavirus Immunization on Childhood Diarrhea in Nicaragua, Research Plan for International Research Scientist Development Award (K01) Fogarty International Center

The impact of universal rotavirus immunization on childhood diarrhea in Nicaragua is unknown. A clear understanding of the magnitude of the effect of UIRI is important information for Nicaragua and other developing world countries who are considering adding rotavirus vaccines to their current vaccine armamentarium. Although preliminary research is measuring the impact of rotavirus immunization in the hospital setting, virtually nothing is known about the effect of UIRI at the primary care or community level. Also, it is not known if genotype shift of the virus is occurring, which could limit the future effectiveness of rotavirus immunization and would inform needed improvements in the vaccine. Finally, we do not know if UIRI is inducing herd immunity. The purpose of this study is to determine the effect of UIRI on diarrheal disease in Nicaragua at the primary care and community levels. Our specific aims are to: 1. Determine the effectiveness of the rotavirus vaccine in primary care clinical practice, using a case-control study. Hypothesis: We expect that UIRI with Rotateq® will have a vaccine effectiveness of about 75% in reducing rotavirus infections that present to primary care centers. 2. Determine the effect of UIRI on diarrhea incidence at the community level, using an existing population-based surveillance system. We will compare incidences prior to UIRI to incidences following UIRI separately for children who did and did not receive the immunization. Hypothesis: Prior hospital-based studies would lead us to expect a one-third reduction in diarrhea incidence among immunized children at the community level. We expect this reduction to be most pronounced during the dry season, when the incidence of rotavirus infection is higher. We expect to find a modest, but measurable reduction in incidence among unimmunized children. 3. Explore if circulating genotypes of the virus have changed following UIRI. We will compare the distribution of rotavirus genotypes prior to UIRI with the distribution following UIRI. Hypothesis: We expect to find a higher percentage of genotypes not covered by the Rotateq® vaccine among immunized children who subsequently develop rotavirus infection. Our analysis of the overall distribution of genotypes following UIRI is exploratory in nature.Master of Public Healt

Multiple Indicator Cluster Survey 2003 in Afghanistan: Outdated Sampling Frame and the Effect of Sampling Weights on Estimates of Maternal and Child Health Coverage

Due to an urgent need for information on the coverage of health service for women and children after the fall of Taliban regime in Afghanistan, a multiple indicator cluster survey (MICS) was conducted in 2003 using the outdated 1979 census as the sampling frame. When 2004 pre-census data became available, population-sampling weights were generated based on the survey-sampling scheme. Using these weights, the population estimates for seven maternal and child healthcare-coverage indicators were generated and compared with the unweighted MICS 2003 estimates. The use of sample weights provided unbiased estimates of population parameters. Results of the comparison of weighted and unweighted estimates showed some wide differences for individual provincial estimates and confidence intervals. However, the mean, median and absolute mean of the differences between weighted and unweighted estimates and their confidence intervals were close to zero for all indicators at the national level. Ranking of the five highest and the five lowest provinces on weighted and unweighted estimates also yielded similar results. The general consistency of results suggests that outdated sampling frames can be appropriate for use in similar situations to obtain initial estimates from household surveys to guide policy and programming directions. However, the power to detect change from these estimates is lower than originally planned, requiring a greater tolerance for error when the data are used as a baseline for evaluation. The generalizability of using outdated sampling frames in similar settings is qualified by the specific characteristics of the MICS 2003—low replacement rate of clusters and zero probability of inclusion of clusters created after the 1979 census

Feasibility and Implementation of a Daily Safety Brief at a Children’s Hospital-in-a-hospital

Holistic and Nursing Scholarship Symposium Event Postershttps://scholarlycommons.libraryinfo.bhs.org/nurs_presentations/1005/thumbnail.jp

Conservative management of a grade V injury to an ectopic pelvic kidney following blunt trauma to the lower abdomen: a case report

<p>Abstract</p> <p>Introduction</p> <p>Ectopic pelvic kidneys represent an anatomic variant that remains clinically asymptomatic in most patients. While there is some literature to suggest that ectopic kidneys may be more predisposed to blunt trauma injuries, there are few examples to guide the management of these injuries. To our knowledge, we present the first case of a grade V renal injury to an ectopic pelvic kidney managed successfully with conservative measures.</p> <p>Case Presentation</p> <p>We present a case of grade V renal injury to an ectopic pelvic kidney in a 21 year-old African-American male. The clinical and radiographic findings are presented, along with the patient's conservative hospital course.</p> <p>Conclusion</p> <p>We suggest that management of grade V renal injuries to ectopic pelvic kidneys can be treated similarly to that of kidneys in normal anatomic position. Conservative measures may be considered in properly selected patients.</p

Benefits of Implementing a Daily Safety Brief at the Baystate Children’s Hospital

Nursing Scholarship Symposium Event Posters.https://scholarlycommons.libraryinfo.bhs.org/nurs_presentations/1001/thumbnail.jp