Compassion in Civic Life

This chapter completes the therapeutic task by critically examining the impact on compassionate relationships of various forms of healthcare citizenship, from the consumer-citizen to the responsibilised citizen to the cosmopolitan citizen. Reflecting the peregrinatio motif, an associative mode of civic life is advocated in which civic society actors have a pivotal role in forming compassionate relationships and sustaining ‘collaborative deliberation’, primarily locally or regionally. A civic life of this sort shares ‘secular’ time, in which people with differing beliefs and experiences meet in respectful if sometimes critical conversation amidst the plurality of civic life. A key source for developing civic life is the democratic capabilities of health professionals and institutions in modelling and shaping compassionate relationships. In this way, a ‘faithful secularity’ fit for healthcare can emerge, keeping faith and full of faith, interweaving the streams of thought about human suffering whereby compassion is filled with content in practice.

SECUKINUMAB FOR TREATMENT OF PATIENTS WITH REFRACTORY PSORIASIS

Refractory psoriasis with a pronounced negative impact on the quality of life of patients is a high percentage. This disease is a difficult therapeutic task, both from a clinical and scientific point of view that indicates search relevance for new methods of treatment. Convincing data confirming the central role of interleukin-17 in the pathogenesis of psoriasis and the importance of biological therapy aimed at interleukin-17 in the treatment of moderate and severe psoriasis, suggest secukinumab as one of the most promising of the currently existing drugs.

Experience in the treatment of immune thrombocytopenia in the Department of Oncohematology of the Voronezh Regional Children’s Clinical Hospital № 1

Introduction. Immune thrombocytopenia (ITP) is a benign hematological disease characterized by an isolated decrease in platelet count, with different course options requiring both an urgent therapeutic decision and clinical observation of patients. At the present stage in the treatment of children with immune thrombocytopenia, especially with the chronic form, significant success has been achieved. Therapeutic options are determined by an individual approach to the patient and are based on the experience of a hematologist. Materials and methods. For the period from 01.01.2013 to 12.31.2017, in the Oncohematological Department of Chemotherapy of the Voronezh Regional Children’s Clinical Hospital № 1, 153 children with various forms of ITP, aged between 1 and 6 months to 17 years, received treatment. Diagnosis and stage of the disease were carried out on the basis of modern clinical guidelines and ITP classification. The analysis of the severity of hemorrhagic syndrome in the diagnosis of ITP was carried out. The principles of patient therapy were based on the pathogenetic aspects of ITP, the stage of the disease. Patients with newly diagnosed ITP (n = 106; 69.4 %), persistent form (n = 26; 16.9 %) received different lines of therapy, provided for by clinical guidelines, some patients were only under the supervision of a hematologist. The chronic form of the course of the disease was formed in 21 (14 %) children out of 153, regardless of the type of treatment. Children with the chronic form received various lines of therapy, including thrombopoietin agonists. The decision to manage such patients was based on a joint discussion with specialists from the largest federal centers. Splenectomy for the above period was performed for 1 child with a pronounced and chronic “wet” component of the disease. Discussion. Treatment of ITP in children, despite the emergence of a new class of drugs with a targeted effect, in some cases is a difficult task for a hematologist. The adoption of a specific therapeutic decision is based on the severity of the clinical and hematological data of the patient, the search for a possible cause of the thrombocytopenic condition, as well as the individual experience of the doctor. Prevention and prevention of bleeding in patients with different ITP, in particular with chronic ITP, with the absence or minimal manifestation of hemorrhagic syndrome according to the principle “0 bleeding per year” is the ultimate therapeutic task. Conclusion. ITP in children, in particular its chronic form, belongs to orphan diseases, therefore, the experience of managing such patients may be useful in determining the overall tactics of treating patients.

DIFFERENTIAL DIAGNOSIS OF THE AUTISTIC SPECTRUM DISORDER AND ASPERGER SYNDROME

The aim of the paper was to described substantial symptoms making possible a clinical differential diagnosis of autism and Asperger syndrome. Those differences do not me rely reflect the intensification of negative features but that Autism and Asperger syndrome are separate syndromes, which, however, share a common spectrum of symptoms. Making a differential diagnosis is essential due to different therapeutic and educational needs of children suffering from those syndromes. The most evident differences are language and communication, manipulative behaviours, social relations as well as manual skills. The first important difference is language, which has been neglected so far since the research concentrated on communication and its disorders. While language is of a high diagnostic value that allows early identification of symptoms specific for Asperger syndrome. The second difference is a very high level of manipulative behaviours in Asperger syndrome which leads to disorders in social functioning of such individuals. Therefore, dealing with manipulation is a significant therapeutic task. At the same time, manipulative behaviours occurring in Asperger syndrome should be distinguished from resistence manifested by autistic children. Moreover, children with Asperger show a need of social relations despite considerable lowering of social competencies, and failures to communicate provoke the intensification of deviant behaviours. Finally, children with autism and Asperger syndrome vary in the level of manual skills. Though initial picture may be very similar, the potential of people with Asperger syndrome for gaining proper graphomotor skills is considerably higher due to the lack of deep disorders in motor planning.

Homework setting in cognitive behavioral therapy: A study of discursive strategies

In recent years cognitive behavioral therapy (CBT), a form of psychotherapy, has risen to prominence due to a large number of studies attesting to its efficacy. A crucial part of the model of CBT is the use of the therapeutic strategy, homework, in which the client undertakes therapeutic tasks between sessions. The focus of this study is on how homework is implemented in sessions of CBT. This is undertaken through an analysis utilizing theme-orientated discourse analysis of video recorded sessions of CBT of one therapist and a client. Through tracking the focal theme of homework, the analysis focuses on homework as a face-threatening act (Brown and Levinson 1987) and how discursive strategies are employed to manage this issue. Other analytic themes include the use of frames (Goffman 1974) and constructed dialogue (Tannen 2007). It is the expertise of the therapist in putting into practice the therapeutic task of homework that is the subject of this study.

Very brief dynamic psychotherapy

The practice of brief psychotherapy is a distillate of the active ingredients in longer-term work but with the addition of two special elements: limited time and therapist activity in formulating a focus and focusing on it. Typically, patient and therapist work together over 10 to 25 sessions in weekly meetings. In very brief dynamic psychotherapy (VBDT), the time frame is shrunk to fewer than 10 sessions, sometimes just a single session; the constraint means that there is less room for corrective manoeuvre in order to achieve the therapeutic task of maximum benefit and minimum harm in the time available. To do this well requires knowledge, skill and sensitivity. In this paper, special attention is paid to a ‘three-plusone’ intervention (brief intervention and followup (BRF)) that has been tested in a randomised controlled trial (RCT).