Biomedical subjects
J Fabricius
Publications and source records attributed to J Fabricius.
Refusal of autonomy: the use of words by a young adult in analysis.
Analytic work with a depressed twenty-three-year-old woman is presented showing how she used ruminative thoughts to maintain a fixed internal dyadic relationship in which neither self not object had autonomy. The resulting omnipotent/impotent impasse meant that she was unable to move forward in her development. In the analysis this relationship was externalized through her use of words, which were employed as actions designed to have a concrete effect on both her self and her analyst. For a long period in the analysis it was essential to understand and interpret the function of her words, rather than to look for symbolic meaning, and it was this which gradually enabled her to take a third, observing, position from which she had greater freedom to operate as a adult.
Has nursing sold its soul? A response to Professor Banks.
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Termination in child analysis. A child-led process?
The paper begins by drawing attention to the disjunction between the theoretical conceptualizations of termination in child analysis and the process as it actually occurs. The central focus is on the process itself. Material is presented from four child analyses to illustrate the idiosyncratic ways in which the termination phase unfolded. The cases selected make it possible to consider termination in relation to each developmental phase. Our central argument is that, although the analyst should have certain criteria for termination in mind, termination in child analysis is essentially a child-led process.
The mutual search for self in the analytic dyad.
Clinical material is presented from seven consecutive sessions in the third year of an analysis to show the way in which patient and analyst worked at the task of allowing each of their separate self and object representations to emerge. These emergent representations are ones in which different aspects of the self, both 'good' and 'bad', are gradually integrated. The continued tension in both participants between an infantile narcissistic view of self and object and a realistic integrated one is highlighted. The way in which the analyst's psychic work on the acceptance of her own narcissism aids the patient's integration of disowned aspects of self is discussed. This material is presented within the framework of ideas about the development of a theory of mind and of reflective self function proposed by Fonagy et al. (1993a, b) and in the context of recent writing on the analyst's unconscious participation in the analytic process, e.g. Levine (1994).
Interpersonal learning in groups: an investigation.
The dissatisfaction of patients with communication in health care has largely been addressed by providing more communication skills training. Research into why skills training might be ineffective has identified various factors, which include organizational resistance, personal defences against anxiety and a need for personal reflection and support. In one college of nurse education small group discussion and reflection had become established practice for students in their first and second clinical experience. The groups met once weekly and were facilitated by a nurse teacher. Discussion was unstructured and focused on the nurse's interpersonal relationship with his or her patients. This project examined one such group and sought to examine the use of small group reflective discussion by nurses about their patients as a means of improving interpersonal communication. The research was conducted over a period of 6 months with nine student nurses meeting once weekly during their first two episodes of clinical experience. Kelly's personal construct theory was used and two repertory grids were constructed by the group. One grid examined processes and change in intrapersonal construing, and the other grid examined processes and change in construing about certain patients. These grids were completed by the students at the beginning and at the termination of the groups. Notes were taken after each group meeting, which recorded impressions and processes; these were discussed once weekly with supervision. The notes were analysed using a grounded theory methodology. The results show some changes in patterns of constructing in relation to self which indicate an increase in anxiety and reluctance to self-reflect.(ABSTRACT TRUNCATED AT 250 WORDS)
Learning to work with feelings--psycho dynamic understanding and small group work with junior student nurses.
A project in which junior student nurses participated in weekly small group discussion about their interactions with patients is described. The rationale for this work, which is based on a psycho dynamic way of thinking and in particular on ideas about psychic functioning in nurses first proposed by Menzies (1959), is outlined. The progress of the work and some of the difficulties are discussed, and some thoughts about future work are put forward.
Left ventricular structural changes in young men at increased risk of developing essential hypertension. Assessment by echocardiography.
Left ventricular structural changes were assessed by echocardiography in young men at increased risk of developing essential hypertension. Four groups were investigated: 28 normotensive offspring of hypertensives (NTO), 20 borderline hypertensive offspring of hypertensives (BHO), 12 borderline hypertensives with normotensive parents (BH) and 28 normotensive subjects with normotensive parents (NT). The septum-posterior wall ratio was increased in the risk groups (NT, BHO, BH). The increased ratio could be explained by both heredity and elevated blood pressure. Left ventricular mass index (LVMI) correlated strongly with physical activity in the NT group, so LVMI was adjusted accordingly. The adjusted LVMI was significantly increased in the risk groups. The increase in the adjusted LVMI could best be explained by the elevated blood pressure and not by heredity. Multivariate analysis of variance showed that physical activity is an independent predictor of LVMI only in the NT group and that systolic blood pressure is an independent predictor of LVMI only in the risk groups.
Reproducibility of histomorphologic diagnoses with special reference to the kappa statistic.
Systems for classification and grading used in pathology should ideally be biologically meaningful and at least be reproducible from one pathologist to another. A statistical method to evaluate reproducibility (non-chance agreement) for several observers using nominal or ordinal categories has been developed and refined over the past few decades--the kappa statistic. A high level of observed agreement among different pathologists can either signify a high level of reproducibility, if agreement by chance is low, or express a low level of reproducibility, if agreement by chance is almost as high as the observed agreement. Therefore, the observed agreement says nothing in itself, unless it is low. The kappa value, however, indicates how much better the observers are compared to a throw of the dice, and therefore gives the real credit to the agreement which was found. We have developed a user-friendly computer program for calculating inter- and intra-observer agreement of 2 or more observers. By calculating associations between different categories and different observers, the statistic furthermore obtains a function close to the parameter of accuracy. We recommend the use of the above method before a set of nominal or rank scale parameters are used for deciding prognosis and treatment of patients. By submitting a diskette the computer program will be available at no cost.
Left ventricular structural and functional changes in young men at increased risk of developing essential hypertension. Assessment by echocardiography.
In order to evaluate if left ventricular structural changes are present in young subjects with increased risk of developing essential hypertension, we have investigated young normotensive and borderline hypertensives with and without hypertensive parents. Our results showed, that left ventricular hypertrophy (LVH) was found in these risk subjects and that LVH was associated to borderline hypertension.
Permanent cardiac pacing and consequences to employment situation.
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Analysis of costs of anaesthetic breathing systems.
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Ketanserin in the treatment of traumatic vasospastic disease.
The specific serotonin receptor blocker ketanserin was given orally to 12 patients with traumatic vasospastic disease in a double blind crossover study. The effect of treatment was assessed by measuring finger systolic pressure and rewarming time after cold provocation and by medical interview and diaries. Median (range) percentage change in finger systolic pressure after cooling was 50 (0-100)% after treatment with ketanserin compared with 0 (0-90)% after placebo. Median (range) rewarming time after cooling decreased from 320 (236-972)s with placebo to 160 (88-404)s after treatment with ketanserin. These changes were not significant. Ninety five percent confidence intervals for difference between the treatments, however, showed that finger systolic pressure may be 80% better and rewarming time 256 seconds faster after treatment with ketanserin than after placebo. The number of attacks did not differ significantly between the two treatments. Two patients had a feeling of warmth in their hands during treatment with ketanserin. The results suggest that orally administered ketanserin may improve digital circulation in patients with traumatic vasospastic disease, but larger numbers of patients are required to assess the true effect of treatment with ketanserin in this disease.
Superiority of multiprogrammable to nonprogrammable VVI pacing: a comparative study with special reference to management of pacing system malfunctions.
Analysis of pacing system malfunctions was performed in 374 patients at initial implantation or at pulse generator and lead replacement during a period of 55 months. A total of 150 nonprogrammable pacemakers were implanted in 148 patients, while 236 multiprogrammable pacemakers were implanted in 226 patients. The purpose of the analysis was to investigate the occurrence and management of malfunction unrelated to pacemaker/lead failure or lead dislodgement. The nonprogrammable group was followed for 3-53 months (median, 36). Malfunction occurred in 18 patients (12.0%): muscle stimulation in 14; exit block in three; sensing problem in one. Surgical correction was necessary in 14 of 18 cases. The multiprogrammable group was followed for 3-52 months (median, 12). Malfunction occurred in 30 cases (12.7%): muscle stimulation in 22; threshold increase in seven; sensing problem in one. Only seven of these patients required surgical correction as 23 cases were successfully managed by reprogramming alone. Malfunctions occurred during a period of several days to 36 months (median, 2.3 months). The difference in rate of secondary surgical intervention was significant (p less than 0.01). Measurements during reoperation in the nonprogrammable group showed that at least 40% of late malfunctions would have been correctable by reprogramming alone. Thus, multiprogrammability is of significant value for noninvasive correction of malfunctions unrelated to pacemaker and lead failures, predominantly muscle stimulation and threshold elevation.
[QT-controlled pacing with automatic regulation of the heart rate].
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[A comparative study of treatment with pacemakers with multiple programmes and non-programmable pacemakers].
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[Peak expiratory flow measurement in 317 Danish schoolchildren].
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