Arbeid med affektintegrasjon i psykoterapi: En mikroanalytisk studie av endringsprosesser i to psykoterapiforløp med godt utfall

Bakgrunn: Denne studien undersøker endringsprosessene i to terapiforløp med godt utfall. Terapeuten oppgir å jobbe etter affektbevissthetsmodellen (ABT), en terapimodell med spesifikt fokus på affektintegrasjon. Modellen er også det teoretiske grunnlaget for denne studien. Vårt formål er å undersøke sammenhenger mellom terapeutens intervensjoner og observerte endringer hos pasientene. Vår hypotese er at terapeutens fokus vil påvirke eventuelle endringer i pasientenes affektbevissthet. I tillegg antar vi at egenskaper ved både terapeuten og pasientene, samt den terapeutiske alliansen dem imellom, vil påvirke utfallet av terapiene. Metode: Studiens datagrunnlag består av lydopptak av terapitimer hentet fra Norsk Multisenterstudie av prosess og utfall i psykoterapi. Et utvalg timer er transkribert og kodet med ARIF, med hensyn til fokusnivå, affektkategorier og relasjonskategorier. Tentative scriptutforminger for de to pasientene er utarbeidet. Videre er dialogene belyst gjennom deskriptiv statistikk og kvalitative analyser. Studien kan dermed betegnes som en naturalistisk og eksplorerende mikroanalytisk kasusstudie med mixed methods-tilnærming. Resultater og konklusjon: Begge pasientene oppnår bedring gjennom terapi, både med hensyn til symptomtrykk, interpersonlige problemer og affektbevissthet. ARIF fremstår som et nyttig rammeverk å vurdere endring innenfor, fordi det kan beskrive strukturelle endringer på en differensiert måte. Til tross for lange forløp synes økningen i affektbevissthet å være noe begrenset hos begge pasientene. I begge terapiene jobbes det etter ABTs prinsipper til en viss grad, da terapeutens etterlevelse av disse fremstår som moderat. Han hjelper pasientene med tydeliggjøring og nyansering på alle ARIFs fokusnivåer. Visse antatt relevante følelser får imidlertid begrenset fokus gjennom begge forløpene. Blant disse inkluderes skam og forakt. En viktig grunn til at terapeuten unnlater å benevne affekter som synes viktige å fokusere på hos de respektive pasientene, virker å være enten at andre affekter prioriteres eller at representasjoner av pasientene selv, andre eller relasjoner får fokus i stedet. I begge forløpene får vi inntrykk av at arbeidsalliansen er god, selv om pasientene virker å utfordre terapeuten på ulike måter. Hans valg av fokus i de to terapiene korresponderer med observerte endringer hos pasientene

Om barnets stilling i saker om avlastningsbolig og barnebolig for barn med nedsatt funksjonsevne. En utredelse av gjeldende rett.

Temaet for avhandlingen er vedtak som gjøres av kommunen om avlastningsbolig og barnebolig. En forelder til et barn med nedsatt funksjonsevne kan søke kommunen om tjenestene. Avhandlingen belyser barnets stilling i disse sakene. Avhandlingen skal belyse de materielle og de prosessuelle rettighetene barnet har. Videre vurderes det om gjeldende rett kommer tilstrekkelig til uttrykk i den nasjonalt utformede lovgivningen. I en barnebolig utføres den daglige omsorgen på vegne av foreldrene på permanent basis. Barnas faste bopel er i barneboligen. Det finnes omtrent 250 barneboligplasser i landet. I motsetning til en barnebolig der barnet har fast bopel, er avlastningsbolig et tilbud om avlastning til familier med hjemmeboende barn. Barnas faste bopel er i disse tilfellene fremdeles hos foreldrene. Avlastningsboligen ivaretar i kortere eller lengre perioder foreldrenes daglige omsorgsoppgave ved at barna flytter inn i denne. Det finnes omtrent 1000 avlastningsbolig-plasser i landet

Mechanical bridge to recovery in fulminant myocarditis.

A patient with acute fulminant lymphocytic myocarditis and cardiogenic shock was successfully treated by mechanical off loading of the left ventricle. A nonpulsatile left-heart bypass was undertaken with an implantable centrifugal blood pump. Careful weaning resulted in device removal on the seventh day. Left and right ventricular function is sustained at 7 months. Widespread application of this method depends on the availability of an inexpensive user friendly blood pump, appropriate weaning protocols and emerging strategies to promote sustainable myocardial recovery

Levels of Lipoprotein (a) in patients with coronary artery disease with and without inflammatory rheumatic disease: A cross-sectional study

OBJECTIVES: Patients with various inflammatory rheumatic diseases (IRDs) have increased risk of atherothrombotic disease. Lipoprotein (a) (Lp(a)) is a risk factor for atherosclerosis but its role in IRD with accompanying coronary artery disease (CAD) is still unclear. We aimed to examine if serum Lp(a) levels differed between CAD patients with and without accompanying IRD. DESIGN: A cross-sectional observational, patient-based cohort study. SETTING: Referred centre for coronary artery bypass grafting in the South Eastern part of Norway. PARTICIPANTS: 67 CAD patients with IRD (CAD/IRD) and 52 CAD patients without IRD (CAD/non-IRD). All patients were Caucasians, aged >18 years, without any clinically significant infection or malignancy. METHODS: Lp(a) levels in serum were analysed by particle enhanced immunoturbidimetric assay, and Lp(a) levels were related to clinical and biochemical characteristics of the patient population. RESULTS: We found no differences in serum levels of Lp(a) between CAD patients with and without IRD. In general, we found that Lp(a) correlated poorly with clinical and biochemical parameters including C reactive protein with the same pattern in the CAD/non-IRD and CAD/IRD groups. CONCLUSIONS: Our data do not support a link between inflammation and Lp(a) levels in CAD and in general Lp(a) levels were not correlated with other risk factors for cardiovascular disease.publishedVersio

Non-operative versus operative treatment of suprasyndesmotic ankle fractures: protocol for a prospective, multicentre, randomised controlled trial

Introduction Surgery is widely recognised as the treatment of choice for suprasyndesmotic ankle fractures, because of the assumption that these injuries yield instability of the ankle joint. Stability assessment of ankle fractures using weightbearing radiographs is now used regularly to guide the treatment of transsyndesmotic and infrasyndesmotic ankle fractures. Patients with a congruent ankle joint on weightbearing radiographs can be treated non-operatively with excellent results. Weightbearing radiographs are, however, rarely performed on suprasyndesmotic fractures due to the assumed unstable nature of these fractures. If weightbearing radiographs can be used to identify suprasyndesmotic fractures suitable for non-operative treatment, we may save patients from the potential burdens of surgery.Our aim is to compare the efficacy of operative and non-operative treatment of patients with suprasyndesmotic ankle fractures that reduce on weightbearing radiographs.Methods and analysis A non-inferiority randomised controlled trial involving 120 patients will be conducted. A total of 120 patients with suprasyndesmotic ankle fractures with an initial radiographic medial clear space of <7 mm will be subjected to weightbearing radiographs. If the tibio-talar joint is completely reduced, we will randomise in a 1:1 ratio to either operative treatment including reduction and fixation of the syndesmosis or non-operative treatment with an orthosis. The primary study outcome is patient-reported ankle function and symptoms as measured by the Olerud-Molander Ankle Score at 2-year follow-up. Secondary outcomes include the Manchester-Oxford Foot Questionnaire, range of motion, radiographic results and rates of adverse events.Ethics and dissemination The Regional Committee for Medical and Health Research South East, group A (permission number: 169307), has granted ethics approval. The results of this study will provide valuable insights for developing future diagnostic and treatment strategies for a common fracture type. The findings will be shared through publication in peer-reviewed journals and presentations at conferences.Trial registration number NCT04615650

Is there a relationship between serum S-100 beta protein and neuropsychologic dysfunction after cardiopulmonary bypass?

Objectives: Over the past decade, the glial protein S-100 beta has been used to detect cerebral injury in a number of clinical settings including cardiac surgery. Previous investigations suggest that S-100 beta is capable of identifying patients with cerebral dysfunction after cardiopulmonary bypass. Whether detection of elevated levels S-100 beta reflects long-term cognitive impairment remains to be shown. The present study evaluated whether perioperative release of S-100 beta after coronary artery operations with cardiopulmonary bypass could predict early or late neuropsychologic impairment. Methods: A total of 100 patients undergoing elective coronary bypass without a previous history of neurologic events were prospectively studied. To exclude noncerebral sources of S-100 beta, we did not use cardiotomy suction or retransfusion of shed mediastinal blood. Serial perioperative measurements of S-100 beta were performed with the use of a new sensitive immunoluminometric assay up to 8 hours after the operation. Patients underwent cognitive testing on a battery of 11 tests before the operation, before discharge from the hospital, and 3 months later. Results: No significant correlation was found between S-100 beta release and neuropsychologic measures either 5 days or 3 months after the operation, Conclusion: Despite using a sensitive immunoluminometric assay of S-100 beta, we found no evidence to support the suggestion that early release of S-100 beta may reflect long-term neurologic injury capable of producing cognitive impairment