PEELING MÉDIO COM ATA E ÓLEO DE CRÓTON EM PELE MADURA: CASO CLÍNICO

Sudden unexpected death in epilepsy

The Effectiveness of the 'Inverted V' Technique for the Anesthetic Blockade of the First Toe

Cardiac rehabilitation (CR) programs are vital for people recovering from cardiac surgeries or events. However, the effectiveness of CR programs varies and some patients may not adhere to them, which might result in less favourable outcomes. Machine Learning (ML) models could help predict the effectiveness and adherence of CR programs. This study proposes two such models: a) the CR program effectiveness prediction model and b) the CR program adherence prediction model. The models were trained on data from retrospective cohort study with 1448 participants collected at the Cardiac Rehabilitation Unit of the Hospital Clinico de Santiago de Compostela in Galicia, Spain (SERGAS). Data cleaning, normalization, imputation, statistical analysis, feature selection and repeated stratified k-fold cross-validation (CV) were applied on the ML pipeline, which tested and evaluated on baseline demographic, clinical, exercise tests and behavioral features. The performance of ML models was assessed by mean Area Under operating characteristic Curve (AUC), specificity, sensitivity, and balanced accuracy with 95% confidence interval (CI). The results show that Random Forest (RF) outperformed other evaluated classifiers for the CR program effectiveness model, with the highest AUC value of 0.789 (0.775, 0.802), while the best classifier for the CR adherence model was the Logistic Regression (LR) classifier, with an AUC value of 0.757 (0.749, 0.764). SHAP plots were also used to investigate the relationships among the variables used in the analysis. Finally, a two-dimensional scoring system was developed to jointly assess predicted adherence and effectiveness, enabling personalized visualization of patient response to CR.

The following summarizes findings of Iris Hilke's case presentation of “Miss Nicht” and two discussions of the case by Rosalind Kindler and Jacqueline Gotthold that were presented in an ongoing annual workshop, “How Child Therapy Informs Adult Treatment.” General ideas about child treatment and how they directly inform the work in adult psychotherapy and psychoanalysis are outlined. For example, a willingness to temporarily suspend a sense of knowing and understanding in favor of affective immersion in the emerging clinical process, or tolerating some of the most intense feelings in the transference/countertransference, is discussed. Because this workshop included mostly clinicians not working with children, a summary of discussion is also described with implications for adult work. Translations of A continuación se resumen las conclusiones del caso clínico de la Sra. Nicht que presentó Iris Hilke, y las dos discusiones del caso por parte de Rosalind Kindler y Jacqueline Gotthold que fueron presentadas en el seminario anual “Qué aprendemos en la terapia infantil que es aplicable a la terapia de adultos.” Se esbozan las ideas generales del tratamiento infantil y como ello puede ser útil para la psicoterapia y el psicoanálisis de adultos. Por ejemplo, la disposición a suspender temporalmente el conocer o el entender a favor de la inmersión afectiva en el proceso clínico que va emergiendo; o se discute la tolerancia a los sentimientos más intensos en la transferencia-contratransferencia. Puesto que en este seminario participaron una mayoría de clínicos que no trabajan con niños, se describe también un resumen de la discusión con las implicaciones para el tratamiento de adultos. Cet article résume les conclusions de la présentation de cas de Miss Nicht par Iris Hilke, et celles des deux discussions du cas par Rosalind Kindler et Jacqueline Gotthold, présentées dans le cadre d'un atelier annuel, “Comment la thérapie d'enfant influence le traitement d'adulte.” L'auteur expose les grandes lignes de certaines idées générales au sujet du traitement d'enfant et de leur influence directe sur le travail en psychothérapie et psychanalyse d'adulte. Par exemple, on y discute de la disponibilité à suspendre temporairement le sentiment de savoir et de comprendre pour favoriser plutôt une immersion affective dans le processus clinique émergent, ou de la tolérance aux plus intenses sentiments dans le transfert/contre transfert. Puisque l'atelier rassemblait pour la plupart des cliniciens qui ne travaillaient pas avec les enfants, le résumé des discussions présente aussi les implications pour le travail avec les adultes. Il lavoro sintetizza la presentazione di Iris Hilke del caso di Miss Nicht e le due discussioni del caso persentate da Rosalind Kindler e Jacqueline Gotthold nel workshop “Come la terapia del bambino informa il trattamento dell'adulto.” Vengono delineate delle idee generali sul trattamento dei bambini e come queste informino direttamente il lavoro nella psicoterapia e nella psicoanalisi degli adulti. Per esempio viene discussa la volontà di sospendere temporaneamente la sensazione di conoscere e comprendere in favore dell'immersione affettiva nel processo clinico che emerge; o il tollerare alcune delle emozioni più intense nel transfert/controtransfert. Dato che questo workshop includeva molti terapeuti che non lavorano con i bambini, viene descritta una sintesi della discussione anche riguardo alle implicazioni per il lavoro con gli adulti. Im Folgenden werden die Ergebnisse von Iris Hilkes Falldarstellung von Fräulein Nicht und zwei Diskussionen des Falles von Rosalind Kindler und Jacqueline Gotthold, die bei dem fortlaufenden jährlichen Workshop: ”Was die Kindertherapie der Erwachsenentherapie zu sagen hat“ dargestellt wurden, zusammengefasst. Allgemeine Vorstellungen zur Kindertherapie und was sie der Erwachsenenpsychotherapie und Psychoanalyse unmittelbar vermittelt, werden in groben Zügen umrissen. So wird zum Beispiel die Bereitschaft zum zeitweiligen Zurückhalten von Wissen und Verstehen zugunsten eines affektiven Eintauchens in den klinischen Prozess sowie das Aushalten höchst intensiver Übertragungs-Gegenübertragungsgefühle diskutiert. Da an diesem Workshop vor allem Therapeuten teilnahmen, die nicht mit Kindern arbeiten, beschreibt die Zusammenfassung der Diskussion die Implikationen für die Arbeit mit Erwachsenen.

Most medical systems allow the printing of biomedical signals onto grid paper. This is used routinely in patient examination, diagnosis and medical history documentation. There are some commercial programs that are able to digitise these biosignals into electronic records, although they are usually restricted to work with only one commercial format. We propose an alternative program capable of recognising and digitising any kind of biosignal paper records, grids, large strips and different speeds by means of an easy procedure. This system is very useful for clinical applications and mainly for improving biosignal databases that allow us to face future studies which would be impossible without this method. The method consists of scanning the biosignals plotted on the paper as an image (BMP files). These records are later processed with proper software, which allows to eliminate the grid lines and all the possible noise present on the paper leaving only the plotted signal. This signal is then converted into numerical values according to a sample rate. The results of this process are ECG or EGM signals ready to be included in a database. We have mainly worked on electrocardiograms, electrograms and blood pressure signals, in collaboration with the Hospital Clinico de Valencia whose doctors have validated the results of this method.

Functional Analytic Psychotherapy is based on principles of radical behaviorism, and emphasizes the contingencies that occur during a therapeutic session, the therapeutic context, functional equivalence, natural reinforcement, and shaping. Depression is a complex problem with multiple causes; the treatment of depression must therefore be approached from different angles. A clinical analysis of a patient with a depressive disorder and its treatment with this type of psychotherapy is presented. The different phases of intervention are described, with examples of the therapeutic relationship. The results were maintained for a period of one year and three months. Key words: DEPRESSION, FUNCTIONAL ANALYSIS, FUNCTIONAL ANALYTIC PSYCHOTHERAPY. Psicoterapia Analitica Funcional esta basada en los principios del conductismo radical y pone el enfasis en las contingencias que ocurren dentro de la sesion terapeutica, en el contexto terapeutico, en la equivalencia funcional, en el reforzamiento natural y en el moldeamiento. Por otro lado, la depresion es un tema complejo y de dificil solucion terapeutica que requiere de una explicacion y una intervencion pluricausal. Se presenta el analisis clinico de un caso que presentaba un trastorno depresivo y su tratamiento a traves de la aplicacion de esta psicoterapia. Se describen las distintas fases de la intervencion con ejemplos de la relacion terapeutica, y el mantenimiento de los resultados durante un periodo de un ano y tres meses. Palabras Clave: DEPRESION, ANALISIS FUNCIONAL, PSICOTERAPIA ANALITICA FUNCIONAL. ********** Functional Analytic Psychotherapy (FAP) (Kohlenberg and Tsai, 1991), along with Acceptance and Commitment Therapy (ACT) (Hayes, Strosahl, and Wilson, 1999), are two approaches to therapy based on the principles of radical behaviorism and on findings regarding functional generalization, functional analysis of language, and equivalence relations. For further information in Spanish about the implementation of FAP and ACT, two pioneering texts published by Perez Alvarez are highly recommended: Tratamientos Psicologicos (1996a) and La Psicoterapia desde un punto de vista conductista (1996b). Functional analytic psychotherapy places emphasis on the contingencies that arise during the session, within the therapeutic context, in functional equivalence, natural reinforcement and shaping (Kohlenberg and Tsai, 1991, 1995). This approach places major importance on what the client says and does in the presence of the therapist, rather than on homework, events that take place in the family setting, or the thoughts the client may have during other parts of his or her daily life. These manifestations are termed clinically relevant behaviors (CRB), and are classified into three types that the therapist should learn to identify as therapeutic goals (Hayes, Kohlenberg and Melancon, 1989; Kohlenberg, Hayes and Tsai, 1993; Kohlenberg and Tsai, 1991, 1994a, 1994b, 1995). The first category of CRB (CRB1) are actual instances of the client's problems during the session, and which the therapist should try to diminish in frequency. Normally, these behaviors are under the control of aversive stimuli and often consist of avoidance behaviors. These problems may involve thoughts, perceptions, feelings, visions or memories that occur in the course of the session. The second category (CRB2) are improvements shown by the client during the session. In the early phases of treatment these behaviors are absent or are manifested only weakly, but as therapy progresses they should become more frequent. Behaviors considered (CRB3) are interpretations by the client of his or her own behavior and its causes. They involve observations and descriptions of the client's own behavior and the reinforcing, discriminative and eliciting stimuli associated with these behaviors. Kohlenberg and Tsai (1991) refer to CRB3 as clients' talking about their own behavior and what seems to cause it, thereby expressing appropriate cause-effect relationships and describing functional relationships that have established the problem. …