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7: Diagnosis and Screening

Sergeant, E. CABI PDF

7

Diagnosis and Screening

7.1  Introduction

Clinicians and pathologists devote substantial time to arriving at the correct diagnosis when investigating disease. The diagnosis is usually reached through a process of clinical examination and assessment and the application of various diagnostic tests. Competent investigators use good judgement, a thorough knowledge of the literature, past experience, diagnostic tests and intuition to organize their observations and reach a diagnosis.

In this context, a test is usually taken to mean a test performed on a specimen in a laboratory. However, in a broader sense, any procedure used to provide information that assists in arriving at a diagnosis (or decision about the status of an animal or group of animals) can be considered a test. Therefore, although the principles discussed in this chapter relate primarily to laboratory-based tests, they also apply to information obtained from the clinical history, physical examination, gross pathology and any other procedures or examinations used to help arrive at a diagnosis.

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Medium 9781855759800

CHAPTER FOUR. Varieties of treatment

Silvia Elena Tendlarz Karnac Books ePub

What does one do with an autistic child who comes for treatment?” This is what the analyst asks when he encounters these children who are locked away in their own worlds. Clinical experience and the theorizations based on it have shown the impasses that are produced by some orientations to treatment. We can examine the diagnostic approaches and treatments proposed for psychotic children by looking at a number of writers of a psychoanalytic orientation.

Margaret Mahler; the case of Stanley (1951)

Margaret Mahler began work in the 1940s at the Children’s Centre of the Psychiatric Institute of the State of New York and Columbia University. In 1948, together with J. Ross and Z. De Fries, she presented a preliminary summary of the findings in sixteen cases of childhood psychosis, entitled “Clinical studies of benign and malignant cases of childhood psychosis (similar to schizophrenia)”. In the 1950s, she introduced her distinction between “early infantile autism” and “symbiotic psychotic syndrome”.

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Medium 9781780644394

27 Technologic Support for Antimicrobial Stewardship

LaPlante. K. CABI PDF

27

Technologic Support for

Antimicrobial Stewardship

Renée-Claude Mercier1* and Carla Walraven2

1

University of New Mexico College of Pharmacy, Albuquerque, New Mexico, US;

University of New Mexico Hospitals Department of Pharmacy Services,

Albuquerque, New Mexico, US

2

Introduction

Over the last 25 years, advances in technology have significantly changed practice within the healthcare setting. From literature searching, e-mail communication, electronic medical records, clinical decision support systems to mobile devices, every component has helped to enhance access to data, and communication with the patient and amongst providers. Technological advances have been of great benefit for most specialties within the hospital, including the antimicrobial stewardship team.

Important aspects of stewardship involve medical chart reviewing and documentation, literature searching, education and communication with healthcare professionals. Technologies that have contributed to facilitating the work of the stewardship team are the focus of this chapter.

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Medium 9780253357090

6 Assisted Reproductive Technologies in Mali and Togo: Circulating Knowledge, Mobile Technology, Transnational Efforts

Dilger, Hansjörg ePub

Viola Hörbst

Aissetou (43), an academically trained Malian, was working for an NGO and was economically independent. She married Moustaffa (45) in 1999. Although both had already had children with other partners, Aissetou and Moustaffa were seeking to have children together. Thus, they began trying to conceive shortly after the wedding. Aissetou visited a gynecologist, who discovered that one of her tubes was blocked. Soon after this, she had an operation in France. Later, in 2004, two myomas were removed in Dakar, Senegal. Aissetou had known about in-vitro fertilization (IVF) for many years as a general possibility for treating female infertility. But it was only in 2005 that a conversation with a Malian friend who was then living in Canada gave her the idea that this might be an option for her. He recommended a Canadian clinic, which she contacted in 2005.

Until this conversation, Aissetou had had doubts about whether IVF could really work and wanted to try what for her seemed more obvious forms of treatment. Nowadays she considers this to have been a serious waste of time that eventually exacerbated her problems. She wanted to go to Canada, but was unable to get a visa from the Canadian embassy in Bamako. She therefore changed her plans and went to Germany instead, where she had relatives. Her husband joined her there for a week, during which an intracytoplasmic sperm injection (ICSI) was carried out. Unfortunately, the procedure failed to result in pregnancy

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Medium 9781780646824

8: Eden’s Garden of South America

Webber, R. CABI PDF

Eden’s Garden of South

America

8

The Peopling of America

The biggest controversy in archaeology is over the time when humans first

­entered the Americas. Established work in North America decided this was about 15,000–17,000 years ago, based on the Clovis culture, for which there are dated artefacts up to 13,000 bp (years before present). Furthermore,

80% of the present North American populations have genetic links to the

Clovis people. However, sites in Chile at Cueva Fell and Monte Verde suggest that people migrated into South America at a much earlier date. There have been remarkable findings at Pedra Furada (now called the Serra da

Capivara National Park), where remains have been dated to 17,000–32,000 bp.

Not only do these dates considerably antedate those of the Clovis culture, but Serra da Capivara is in Brazil, inland from Recife, on the east side of

South America, thus suggesting that ancient peoples travelled into what is now the Amazon, as well as ­following down the Pacific coast, as had always been presumed.

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Medium 9780946439089

11. Lies and the Thinker

Wilfred R. Bion Karnac Books ePub

The distinction between truth and lie constantly confronts the psycho-analyst who has to apply in a rough and ready practical way ideas that have been the centre of discussion over the centuries. The rough and ready application may be too crude to do the work required of it. The psycho-analyst seeks ideas sufficiently accurate and robust to survive the emotional storms they should illuminate.

To the problems of understanding I have said that the psycho-analyst can bring something that is unknown to the philosopher of science because the psycho-analyst has experience of the dynamics of misunderstanding-, the psychoanalyst is concerned practically with a problem that the philosopher approaches theoretically. Investigations of understanding and misunderstanding impinge on problems associated with truth and untruth. The reality of the problem becomes apparent when the psycho-analyst must ask himself, can a liar be psycho-analysed?

The problem can be formulated in grid terms without moral overtones. Category 2 (reserved for formulations known by the initiator to be false but maintained as a barrier against statements that lead to a psychological upheaval) would seem provisionally to offer a home to the lie. Such a categorization supposes that an experience has been permitted to continue to a point where the patient thinks he knows his formulation to be untrue, but is it true that he maintains it because it would be disturbing to his development not to do so? The lie could be uttered because in the view of the liar it would be profitable to him or injurious to another: is it correct in such a case to say it would be true, and if true significant, that inability to profit himself or injure another would lead to his having a psychological upheaval?

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Medium 9781855753457

CHAPTER THREE: The psychological assessment

Elisabeth Cleve Karnac Books ePub

Here we go

Douglas goes through a comprehensive psychological assessment, which I conduct. My wish is to obtain a picture of his psychological and neuropsychiatric status as well as an idea of his intellectual capacities. I use tests that measure several different aspects of his personality. It is necessary to carry out a broad psychological survey in order to illuminate both Douglas’s strong and weak sides. He is tested with so-called projective personality tests, which elucidate unconscious psychological processes. They can provide hypotheses on how mild or severe his personality disorder is. He is also given an intelligence test, which measures his general aptitude. I also test him with neuropsychological tests, which can indicate whether he has brain dysfunctions.

An important part of the assessment consists of everything Margareta and Gunnar say about Douglas’s earlier and present life, how he functions psychically, his somatic condition, and how he behaves with other people. For children who have had such a difficult start in life as Douglas, it is especially important to know as much as possible about the infancy period. In Douglas’s case, there is a considerable amount of information on how deprived he was from the very start of his life.

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Medium 9781937554996

5 The Infinite and Sacred Nature of Being

Lucia Thornton Sigma Theta Tau International ePub

“We are not human beings having a spiritual experience, rather we are spiritual beings having a human experience.”

–Pierre Teilhard de Chardin

Redefining who we are as human beings is a primary focus of the model of whole-person caring. Broadening our self-perception from biomedical entities to a perspective that acknowledges our spiritual nature is essential. The schism that took place more than 300 years ago between the body, mind, and spirit needs to be bridged. We have neglected our humanity and relegated those things that enliven us, such as love, caring, and compassion, to the backburner.

We are out of balance and need to recover that which we have lost. The dramatic rise in recent years in consumers seeking alternative care is related to a need to be touched and cared for at a more personal level. While today’s health care culture is one of brilliant intellectual achievements and remarkable technological advances, spirituality and the human soul have been largely overlooked. Redefining who we are as human beings will not immediately change the way we practice, but it is important that we begin the dialogue.

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Medium 9781855754195

7: The oh-so-good angel and the sock

Michael Gunter Karnac Books ePub

Elisa, aged ten years and nine months, was admitted to the clinic for child and adolescent psychiatry because she was suffering from severe encopresis. She had soiled herself several times a day since early childhood with one doubtful interruption of six months, withdrew from social contact, and barely spoke to people outside the family. Since the age of three or four she had received occasional therapy because she displayed general developmental delay. At school and with her peers, on the one hand she was an outsider and was teased (among other names she was called Stink-bomb); on the other hand she often allowed her schoolmates to harass her sexually without being able to set any limits to it. Sometimes she triggered these encounters herself. Staff at the day care group she attended described her as scruffy and neglected. She was finally excluded from the centre and was about to be expelled from school. On first impression the girl seemed to be mentally retarded not only in her appearance but also in her behaviour. She initially made virtually no verbal contact, after admission to the children ’s ward she behaved increasingly like a three-year-old, and if she spoke to us at all, she communicated exclusively in one- or two-word sentences. Her linguistic repertoire in vocabulary and intonation was taken almost exclusively from “Teletubbies ”, a television programme for toddlers. She spoke like the Teletubbies, behaved like a Teletubby, and seemed to live in this harmonious toddler phantasy world. As regards her symptoms, she showed no sign of motivation to change and consistently refused to go to the toilet to pass stools.

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Medium 9781855755185

CHAPTER FIVE. A baby’s “broken bridge” to the parents

Jeanne Magagna Karnac Books ePub

Jeanne Magagna

When a baby–mother/father relationship works, the baby keeps alive the desire to communicate with the parents through eyes, mouth, hands, body, and mind. The desire to be perceived and fully understood by his parents becomes a passionate one as the baby falls more deeply in love with his parents. He moves from crying to pointing to speaking and symbolically playing out his experiences as part of an intense wish to share emotional experiences and interests with them.

Unfortunately, pre-verbal relationships with the parents do not work for every baby, and the emotional bridge connecting the baby to his parents is sometimes broken. When this happens, a basic fault (Balint, 1968) occurs in the development of his personality. When faced with an emotional crisis at a later point in his life, the child will then be at risk of regression to not-talking, not-eating, and not being open to anything the parents have to offer him.

In infancy, when the emotional bridge to the parents is damaged or broken, the infant is desperate and tries to find a way of coping with the fear of dying, the anxieties regarding emotional disintegration, and the pain of being left alone. In early infancy, the baby lacks the inner capacities to bear such emotional experiences. Deprived of parents who are sufficiently responsive to his own particular needs, the baby turns to self-protection for safety. Not-thinking (Emanuel, 2001), often referred to as dissociation, becomes frequently resorted to as a primitive protection. Other primitive protections also develop as ways to keep the baby away from the risk of being vulnerable through needing parents who are not available to help him.

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Medium 9781855753228

9. Assessing the Risk of Self Harm in Adolescents: A Psychoanalytical Perspective

Emanuela Quagliata Karnac Books ePub

Robin Anderson

INTRODUCTION

The risk of self harm rises dramatically in adolescence. Suicide, attempted suicide, and other forms of self harm are rare in younger children, but once adolescence is reached the rate of deliberate self harm rises steeply. In 1990 the suicide rates per million for 15-19 year olds in England and Wales for males and females were 57 and 14 respectively. This is almost certainly an underestimate because of the reluctance of Coroners’ courts in this country to bring a verdict of suicide for all but the most certain cases. Even so, mortality rates were only higher for accidents. [Of course many fatal teenage accidents may have a suicidal aspect to them as well.] Of great concern at the present time is the increase in the male suicides in this age group. Between 1980 and 1990 the increase was 78%. This is particularly disturbing because the rate for adolescent girls and for all other age groups is falling (Flisher, A. 1999).

Seventy-one per million is of course a very small proportion though even one wasted life would be too many. The effect on others of an adolescent suicide cannot, however, be over-estimated. It is a trauma which is devastating for other family members who frequently suffer for years afterwards. Siblings can have their own development grossly interfered with and are at risk of suicide themselves. It is also deeply upsetting for the surrounding community, especially in schools and on university campuses where it can trigger off waves of suicide attempts or even actual suicides. Where the young person has been receiving help from professionals it is very distressing for them too, giving rise to strong feelings of guilt and distress and loss of a sense of competence. Often the situation is noc helped by the ensuing inquiries which can become dominated by hostile and blaming attitudes, which are at the heart of suicidal behaviour and die response it can evoke.

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Medium 9781855758094

CHAPTER THREE: Concepts, feelings, and expectations

W.M. Bernstein Karnac Books ePub

The word “concept” comes variously from the Latin concipere and capere. These mean respectively “to take in” and “to capture”. Of course, “concept” is more or less synonymous with “idea”. But “to conceptualize” has a “mental process” quality, while “idea” has a “mental structure” connotation. The conceptual process very literally “captures” sensations or perceptions or other concepts. Concepts “take things in”. Or, when we remember apperception, Wundt's (1874) word for thinking, we might say best that concepts perform an act of re-perceiving sensations so that their meanings or implications can be inferred. Conceptualization has vast potential for regulating the feeling and overt behavioural reactions to sensory perceptions; and, in turn, stimulating and regulating further conceptualization.

The term schema has a long history in psychology to denote mental structures that organize and interpret events. Piaget (1928; 1954) used the term to describe what gets developed with learning. Kant (1781) assumed that schemas were applied to understand sense data. I use the term concept here in similar ways.

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Medium 9781780644554

2: The Planning Process

Wapling, A. CABI PDF

2 

The Planning Process

C. Sellwood1 and A. Wapling2

National Lead Pandemic Influenza, NHS England, London, UK; and Honorary

Associate Professor, Health Emergency Preparedness, Resilience and

Response, University of Nottingham, Nottingham, UK

2

Regional Head of Emergency Preparedness, Resilience and Response, NHS

England (South), UK

1

Key Questions 

• What is the process that should be adopted to undertake effective emergency preparedness?

• What are the stages that can be followed within this process?

• How often should the process be revisited?

2.1  Introduction

One of the greatest benefits of the emergency planning process is not

­necessarily the plan that is delivered at the end, but the actual process of

­developing the plan. Additionally, this often helpfully identifies who to speak to, how to communicate with them and, perversely, what NOT to do, all of which are essential aspects of responding promptly, appropriately and safely to a major incident. This chapter, which is based on a wider discussion on emergency preparedness and business continuity in Pandemic Influenza,

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Medium 9781855759688

23. Parallel directions in psychoanalysis

Donald Meltzer Karnac Books ePub

Margot Waddell

The human nature unto which I felt
That I belonged, and reverenced with love,
Was not a punctual presence, but a spirit
Diffused through time and space, with aid derived
Of evidence from monuments, erect,
Prostrate, or leaning towards their common rest
In earth, the widely scattered wreck sublime
Of vanished nations.

[Wordsworth, The Prelude]1

In his definitive statement of the life of the mind as “The Vale of Soul-making”,2 Keats distinguishes between those who are genuinely able to explore the further chambers, the inner recesses and dark passages of what he had earlier called the “large Mansion of Many Apartments”—human life, and those who stopped thinking, or at least did not “think into the human heart”.3 The Soul-making emphasis in the experience of life, lies in the capacity to tolerate the perception that “the world is full of Misery and Heartbreak, Pain, Sickness and oppres-sion”.4 That knowledge is co-terminous with the realization that it is in apprehending that very reality that the many doors open from the Chamber of Maiden Thought. In a world of Circumstances, it is the Heart which is “the teat from which the Mind or intelligence sucks its

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Medium 9780253014856

14 A Case Study of Transnational Flows of Chinese Medical Professionals: China Medical Board and Rockefeller Foundation Fellows

Bridie Andrews Indiana University Press ePub

COMPELLING QUESTIONS ABOUT human health have motivated the transnational flow of physicians for millennia. Egypt was seen as the font of medical knowledge by the Greeks, Persians, and Turkic kingdoms from the thirteenth century BCE to the Roman era. Egyptian physicians were dispatched to the ancient courts of Europe and the Middle East while medical writers plumbed ancient Egyptian texts for knowledge of ancient Egyptian pharmaceutical formulas. In the first millennium AD, Arabic physicians first retrieved and then reinterpreted the classical Greek medical traditions of Hippocrates and Galen. In Asia, trade routes between the Middle East, the Indian subcontinent, and China facilitated the flows of medical practitioners and ideas from west to east and east to west. In her book Needles, Herbs, Gods, and Ghosts: China, Healing, and the West to 1848, Linda Barnes (2000) details the multiple Chinese influences on European medicine in the early modern era. During the sixteenth and seventeenth centuries the Jesuits included medicine in the intellectual repertoire they brought to the late Ming and early Qing courts.

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