bluuebunny/crossref_metadata_2025 huggingface dataset:
Notes on the Time Factor in Treatment
Authors: Winnicott Donald W.
Published: March 2017

In this talk to staff of a local council Children’s Department, Winnicott explains why, in the psychoanalytic process, time is a major factor in treatment and gives instances from his clinical work to support this. Unconscious processes, which are timeless, are addressed in analysis; these then become better integrated over time with conscious functioning, which is time based, and the patient may over many years begin to develop and improve his life.
Letter to Pearl King
Authors: Winnicott Donald W.
Published: March 2017

In this letter to his colleague Pearl King, Winnicott expresses his personal view that any books chosen for the International Library of Psychoanalysis publications should reflect the given author’s work within clinical psychoanalysis. He suggests that, although any book written by Dr John Bowlby would be popular and profitable, he does not qualify for publication in the International Psycho-Analytical Library on these grounds. Winnicott wants this matter discussed in committee by the Society.
Matti, aet 12½ Years: A Therapeutic Consultation
Authors: Winnicott Donald W.
Published: March 2017

In this therapeutic consultation with a young child with symptoms of encopresis and antisocial features, Winnicott uses his squiggle technique to diagnose difficulties within the family contributing the child’s behaviour and functioning. The consultation is in Finnish and is assisted by an interpreter.
Letter to Wilfred Bion
Authors: Winnicott Donald W.
Published: March 2017

In this letter, Winnicott comments on the value of Bion’s work and asks him to explore further the relationship between Bion’s account and his own of the development of the mind as a means employed by the baby for lessening the narcissistic wound of the reality principle. He is aware that they use different language to address what may be common ground between them.
The Five-Year-Old
Authors: Winnicott Donald W.
Published: March 2017

In this BBC radio broadcast, Winnicott charts the development of the infant in the safety of home and family, initially unaware of conscious dependence on all around him, until the start of school. Winnicott gives examples of the child’s entry into a shared, more objective reality, one requiring him and his parents to adapt. Children negotiate this in different ways. The child may use his attachment to a loved object to make this transition to school. Parents feel sadness, hope and excitement about this transition. A child’s reversal into the pre-school world and then shifting into the more mature stage of school is normal for the child and the parents.
The Beginnings of a Formulation of an Appreciation and Criticism of Klein’s Envy Statement
Authors: Winnicott Donald W.
Published: March 2017

In this piece, Winnicott formulates his appreciation and his criticism of Melanie Klein’s paper on envy at the 1955 IPA Congress, and her book Envy and Gratitude. He asserts that the human infant is too immature to experience envy as described by Klein and that inherited or innate aggression cannot be assumed until the mixture of heredity and environment is properly understood. He gives two clinical examples from his own analytic work and shows that the early pre-objective reality experience of the infant, to which the mother (analyst) must adapt, allows for a progression of self from unconscious to more conscious awareness, of need and dependence on the external and the real. If this gradual progress goes well, envy need not be posited. If it doesn’t go well, the infant self (within the adult patient) may attack and show aggression at the mother’s (analyst’s) failure to respond or adapt appropriately.
The Development of the Capacity for Concern
Authors: Winnicott Donald W.
Published: March 2017

This paper given to the Topeka Psychoanalytic Society, Kansas, addresses the development of the child’s capacity for concern. For Winnicott, concern is the opposite of guilt. He elaborates this by describing how the infant fuses the affectionate mother who provides a benign environment with the object-mother who arouses cruder instincts. Learning to manage this and to have a mother who understands and bears it enables the child eventually to recognize a living separate mother who survives his needy attacks and loves him in return. This baby can then begin to take responsibility for himself and his needs (integration of emotional life) and to be concerned for his mother. This is a repeated learning cycle throughout childhood and into adulthood. The mother’s failure to survive may create a failure of concern.
The Psycho-Analyst and Child Psychiatry: A Matter of Economics
Authors: Winnicott Donald W.
Published: March 2017

In this short note for discussion which he hopes to amplify with hospital work examples, Winnicott proposes that the trained psychoanalyst may be the best person to become a child psychiatrist. He lists areas where the role of the psychoanalyst as ‘child psychiatrist’ would be advantageous.
Letter to Ronald MacKeith
Authors: Winnicott Donald W.
Published: March 2017

In this letter, Winnicott complains of his treatment at MacKeith’s hands in relation to paediatrics and child psychiatry.
The Mentally Ill in Your Caseload
Authors: Winnicott Donald W.
Published: March 2017

In this talk delivered to social workers, Winnicott brings his understanding of professional psychiatry, with its attempts to treat severe mental illness using a more humane approach, together with his belief in dynamic psychology—the emotional development of the individual derived from the study of psychoanalysis—into a closer connection with one another. He charts a brief outline of psychoanalysis and interprets the psychoses through it. He sees the importance of early environmental factors in mental illness and the possible effects of this on maturation. He comments on depression both normal and psychotic in type, on his theories of personalization, of feeling real, and, through early dependence, the gradual growth of the functioning self. He also gives an empathic view of the role of the social worker in the difficult work of treating acute mental ill health.
Psychotherapy of Character Disorders
Authors: Winnicott Donald W.
Published: March 2017

In this paper to the European Child Psychiatry Congress in Rome, Winnicott states that character disorders are the result of a distortion in ego development and integration by the growing child. An antisocial tendency may then emerge due to a deprivation or trauma that cannot be managed at the given age and maturation of the child. Such disorder impoverishes the personality, often giving a sense of grievance and feelings of purposelessness and unreality, and it leads to difficulties in socialising and often court attendance. Psychotherapy of these disorders requires a return to the phase prior to deprivation or trauma. Clinical examples of child cases are given.
Two Notes on the Use of Silence
Authors: Winnicott Donald W.
Published: March 2017

In these two notes on the case of a woman he is treating, Winnicott says that the basis of the analysis at this stage is his silence and that this is something the patient feels she has achieved. Winnicott describes accepting his position as someone who says nothing because in this kind of analysis it is essential for the analyst to accept certain ideas about himself which come from the patient. In the second note, Winnicott refers to problems that arise out of the analyst not speaking; namely, the assumption that the analyst knows what is going on and that one purpose of interpretation is to establish the limits of the analyst’s understanding. He notes two further themes in this analysis: that of blond hair —which in this case relates to triangular relationships with whole people—and the theme of doom or fate.
Youth Will Not Sleep
Authors: Winnicott Donald W.
Published: March 2017

In this essay for New Society, Winnicott discusses the normal restlessness and rebellion of adolescence and possible solutions from a psychological perspective. He recognises that the young, who may have been let down environmentally in the early stages of life, will challenge and disrupt the status quo: society. He considers that the potential of youth to do good and conform and identify with society is equally as present as the potential to act out antisocially and turn to crime. He proposes that allowing time and accepting that the young live in a state of ‘not knowing whither’ must be recognised.
Review: Memories, Dreams, Reflections
Authors: Winnicott Donald W.
Published: March 2017

Winnicott’s extensive review of Jung’s Memories, Dreams, Reflections’ focuses on the autobiographical first three chapters of the book that ‘every psychoanalyst must read’ and in particular the first chapter, ‘First Years’. Winnicott discusses the relationship between Freud and Jung. He then analyses Jung’s early experiences of psychotic illness from around the age of 4 from within Winnicott’s own theoretical framework. Winnicott goes on to discuss the Jungian ‘unconscious’ and Jung’s use of the word ‘self’.
Introduction to The Child, the Family, and the Outside World
Authors: Winnicott Donald W.
Published: March 2017

In Winnicott’s introduction to his book The Child, the Family and the Outside World, newly published by Pelican in 1964, he stresses that the best mothering comes out of the mother’s natural self-reliance and ordinary devotion. While some of the book is addressed directly to mothers, in his view it is not essential for mothers to read books about childcare. Winnicott hopes to give support to mothers in their reliance on their own natural tendencies.
Roots of Aggression
Authors: Winnicott Donald W.
Published: March 2017

In this paper, Winnicott states that the care of babies and children is complicated by destructive episodes that may need management and understanding. Human aggression is seen by Winnicott as innate and as both a normal reaction to frustration and also as evidence of life energy. He also sees a child’s striking out at the external world as inevitable reality testing. He speaks of a child’s dreaming, playing and fantasising as part of the processes of making aggression manageable, and he also highlights constructive urges alongside the destructive side. He points out that love and hate, creating and destroying are part of the same process for a child, and learning how to manage this is part of the child coming to maturity and harnessing these innate aggressive forces to the task of living, loving, playing and (eventually) working.
Comment on Obsessional Neurosis and ‘Frankie’
Authors: Winnicott Donald W.
Published: March 2017

Winnicott’s contribution to a discussion of a case of obsessional neurosis given by Bertha Bornstein to the Amsterdam International Psychoanalytic Congress. In regard to the theory of obsessional neurosis, Winnicott formulates a concept of a split-off intellectual functioning as an essential feature of a thorough-going obsessional neurosis case. In this case, Winnicott believes it is possible to think that the mother of Frankie was interfered with, in her first relationship to this boy, by unconscious features derived from her relationship to her own brother and that the whole of the case could be described and understood around this detail.
Review: Normality and Pathology in Childhood
Authors: Winnicott Donald W.
Published: March 2017

A draft of a review by Winnicott of Anna Freud’s Normality and Pathology in Childhood, including a detailed synopsis of the chapters of the book. Winnicott describes the book as an up-to-date statement of Anna Freud’s theory, whose idea is ‘not so much an idea as an orthodoxy which may be used by anyone’.
Case Notes for a Psychoanalytic Seminar: Withdrawal, Regression, Male Identification
Authors: Winnicott Donald W.
Published: March 2017

In this brief note, Winnicott describes a woman patient, aged 27 years, and her differing states in successive sessions. In the first session described, the patient was already disillusioned and becoming devoid of affect; Winnicott applies the word ‘withdrawal’. Winnicott states that in regression there is dependence but that in withdrawal there is a pathological independence. He discusses the patient’s anger and the need for himself as the analyst to put up with her extreme reactions as she operated within a delusional transference.
Dissociation Revealed in a Therapeutic Consultation
Authors: Winnicott Donald W.
Published: March 2017

Winnicott discusses one detail of the antisocial clinical picture to illustrate the feature of dissociation, which recurs regularly in case histories. He illustrates this using a psychotherapeutic interview with a girl of eight years, which led to a cessation of stealing and which Winnicott believes was therefore significant. He writes that the child who does not acknowledge the antisocial act is the child who is in distress and who wants help and who can be helped. Another example concerns a deprived child who craved friendship but could not achieve it and did not make friends easily. The child was aware that he was suffering from a compulsion, but could not believe in what he had done under this compulsion, showing the dissociation in his psyche. Winnicott maintains that antisocial behaviour in a child is linked to a loss of hope—disillusionment—which needs to be returned to in order to recover the capacity for hope.
Social Aspects of Autism
Authors: Winnicott Donald W.
Published: March 2017

This is a draft of Winnicott’s paper on autism. He is aware that some of his comments on autism have caused distress, and he sees this lecture as an opportunity to correct some misunderstandings. From Winnicott’s point of view there is no distinction in definition between autism and schizophrenia in childhood. Autism is a paediatric term and, in using it, paediatricians are glancing over their shoulder at emotional disorders which do not readily classify themselves as physical illnesses do. Winnicott also discusses parental guilt.
Review: Infantile Autism
Authors: Winnicott Donald W.
Published: March 2017

Winnicott’s review of Rimland’s book Infantile Autism. After many years of experience, Winnicott does not clearly see why those described as having infantile autism should be theoretically cut off from the total subject of schizophrenia of infancy and childhood apart from teaching purposes. For Winnicott, Rimland is not up to date with regard to the study of the earliest stages of integration of the personality derived from the theories of psychoanalysis. For Winnicott, the mental health of the individual is laid down at the beginning of life, when the infant’s dependence on the mother and her care is nearly absolute.
Letter to Renata Gaddini
Authors: Winnicott Donald W.
Published: March 2017

Winnicott’s letter to Renata Gaddini on the difficulties of translating the words ‘doldrums’ and ‘gentleman crook’ from English into Italian, for Gaddini’s Italian translation of Winnicott’s book The Family and Individual Development.
Review: Asthma: Attitude and Milieu
Authors: Winnicott Donald W.
Published: March 2017

Winnicott’s review of Asthma by Aaron Lask. Winnicott finds this a valuable study of 100 asthma patients, noting that Lask and his colleagues are to be congratulated on this fruitful application of what Balint is trying to teach to general practitioners.
Letter to Renata Gaddini
Authors: Winnicott Donald W.
Published: March 2017

Letter from Winnicott to Renata Gaddini on translating a sentence from his book The Family and Individual Development into Italian.
Letter to Wilfred R. Bion
Authors: Winnicott Donald W.
Published: March 2017

Letter from Winnicott to Dr Bion on Bion’s use of the terms ‘memory’ and ‘desire’.
The Concept of Clinical Regression Compared with that of Defence Organization
Authors: Winnicott Donald W.
Published: March 2017

In this lecture to psychotherapy symposium at McLean Hospital, Belmont, Massachusetts, Winnicott discusses the treatment and understanding of the psychoses from a clinical psychoanalytical perspective, with an emphasis on a particular kind of regression in the clinical psychoanalytic setting, in which regression is not a matter of the standard defences deployed against recovery. Rather, regression may occur where a patient needs the analyst to provide a dependability originally lacking in early life and in which real needs have to be met for the first time for forward movement to resume in the patient’s development.
Letter to Marjorie Spence
Authors: Winnicott Donald W.
Published: March 2017

Letter from Winnicott to a Mrs Spence on anger in babies and avoiding giving advice in his books.
Addendum to ‘The Location of Cultural Experience’
Authors: Winnicott Donald W.
Published: March 2017

In this further short piece related to his paper ‘The Location of Cultural Experience’, Winnicott uses his clinical experience and his own dreaming ‘on the sleep side of the line between waking and dreaming’ to describe the inner as well as the outer location of cultural experience. Winnicott locates this place, from which the artist might create his writing in us all.
Foreword to Disturbed Children
Authors: Winnicott Donald W.
Published: March 2017

Winnicott’s foreword in Robert Tod Disturbed Children recommending it to students and workers in residential work with disturbed children.
Playing
Authors: Winnicott Donald W.
Published: March 2017

In this paper, Winnicott makes a theoretical statement about what psychotherapy and psychoanalysis do. For him, the work of therapy is a form of playing, and it occurs in the area of overlap between patient and analyst. If the therapeutic process is successful, the patient who cannot ‘play’ is enabled to do so. Winnicott looks at play in relation to masturbation, at his own concept of transitional phenomena, at play in time and space, and uses illustrative cases to make his points. He summarises that the child in play is investing external realities with his dreaming self and its meaning and feelings.
Letter to Mrs T.
Authors: Winnicott Donald W.
Published: March 2017

Letter from Winnicott to a Mrs T. on her daughter’s hair-pulling.
First Interview with Child May Start Resumption of Maturation
Authors: Winnicott Donald W.
Published: March 2017

This short statement is a report of a lecture by Winnicott to the American Association of Psychiatric Clinics for Children on using the first therapeutic interview with children and how these interviews may enable maturation to re-start. He suggests that if the interview enables a development (halted for various reasons) to restart, the family relationships can take over the normal work for the child. The tendency to maturity, the facilitating environment, and the movement towards health in most children is suggested. Winnicott says that although psychoanalysis and a single psychotherapeutic interview are very different technical processes, they can be complementary in the various changes they may bring about.
Letter to Joyce Coles
Authors: Winnicott Donald W.
Published: March 2017

Winnicott writes from Lenox Hill Hospital in New York to his long-standing secretary Joyce Coles, with more hope of his continuing slow progress of recovery from a serious heart condition.
Letter to Michael B. Conran
Authors: Winnicott Donald W.
Published: March 2017

Letter to Michael Conran regarding a patient.
Physiotherapy and Human Relations
Authors: Winnicott Donald W.
Published: March 2017

In this paper on psycho-somatic disorders, Winnicott begins by acknowledging the vastness of the subject. Psycho-somatic disorder merges into the universal problem of the healthy interaction between the psyche and the soma—that is, between the personality of an individual and the body in which the person lives. The relationship between body and mind, role of early development and stages of emotional development are also discussed.
Moon Landing
Authors: Winnicott Donald W.
Published: March 2017

A poem on the moon landing in 1969 and its significance to Winnicott.
Letter to Helm Stierlin
Authors: Winnicott Donald W.
Published: March 2017

Winnicott’s letter to Helm Stierlin on his book Conflict and Reconciliation.
The Pill
Authors: Winnicott Donald W.
Published: March 2017

In this lecture to the Progressive League, Winnicott explores the ideas around contraception by means of the unconscious as well as the conscious processes involved in the cases of a young woman and an older woman and the unconscious conflicts for each of them around the availability of contraception through the pill.
Mother’s Madness Appearing in the Clinical Material as an Ego-Alien Factor
Authors: Winnicott Donald W.
Published: March 2017

This paper gives the description of a case where the sudden intrusion of ‘foreign’ material needed to be noticed, understood and interpreted. Winnicott’s patient, a boy of 6 years, was referred to him on account of his being unable to make use of his good intelligence; instead, he would bite holes in his gloves, coat, tie and jersey, and he would only defecate in a chamber pot near one of the parents. The boy demanded a routine that was strict in many details and was therefore restricted in the foods he could eat. Winnicott gives a description of the interview with the boy: the only occasion he saw him. He reports that the interview had a good effect because he was able to sort out the muddle in the boy’s mind from the muddle introduced into his life by certain characteristics of the mother.
Letter to Peter Giovacchini
Authors: Winnicott Donald W.
Published: March 2017

Letter to Dr Giovacchini on reprinting his ‘Confrontation’ paper (‘Contemporary Concepts of Adolescent Development and Their Implications for Higher Education’).
Contribution to the Final Number of Case Conference
Authors: Winnicott Donald W.
Published: March 2017

In this short contribution, Winnicott expresses his feelings about the importance of journals to writers. Winnicott reminisces about Peggy Volkov (who gave him his first commission of a case history for The New Era in Home and School), Janet Quigley and Isa Benzie (his producers at the BBC), and Kay McDougall, editor of Case Conference. He expresses grief at the closing down of the journal and how he and other writers had been able to use it to convert their personal discomfort into relief and communication.
Dependence in Child Care
Authors: Winnicott Donald W.
Published: March 2017

In this paper, Winnicott argues that it is valuable to recognize the fact of dependence. He describes the various stages of steady development of the growing child from absolute dependence through lessening degrees of dependence and towards independence.
Letter to Jeannine Kalmanovitch
Authors: Winnicott Donald W.
Published: March 2017

Letter to Dr Gaddini on her translation of his work, focussing on the word ‘self’ and his understanding of this word.
Transitional Objects and Transitional Phenomena
Authors: Winnicott Donald W.
Published: March 2017

In this paper, Winnicott describes the interstices between illusion and reality and their importance in emotional development. He discusses in detail the use of transitional objects by the infant, and uses two clinical examples to illustrate how the object becomes decathected as cultural interests develop.
Contemporary Concepts of Adolescent Development and Their Implications for Higher Education
Authors: Winnicott Donald W.
Published: March 2017

In this lecture to the British Student Health Association, Winnicott explains his views on development, growth and the immaturity inherent in adolescence.
A Note on the Mother-Foetus Relationship
Authors: Winnicott Donald W.
Published: March 2017

In this note, Winnicott states that although in psycho-analytic literature there are copious references to the mother’s conscious and unconscious fantasies about her child, there is also a simple biological statement: the ability of the mother to produce a real whole live baby. Winnicott further discusses the disappointment that mothers and fathers may feel if their child is born with a defect and the repercussions of not being able to produce a fantasy of a 100 percent functioning human being.
Acknowledgements
Authors: Winnicott Donald W.
Published: March 2017

Winnicott’s acknowledgements to the 1971 publication of Therapeutic Consultations in Child Psychiatry
Case XII: ‘Milton’ aet 8 Years
Authors: Winnicott Donald W.
Published: March 2017

This is case XII in part 2 of Winnicott’s book Therapeutic Consultations in Child Psychiatry: the case of ‘Milton’ aet 8 years.
Case XIV: ‘Cecil’ aet 21 Months at First Consultation
Authors: Winnicott Donald W.
Published: March 2017

This is case XIV in part 3 of Winnicott’s book Therapeutic Consultations in Child Psychiatry: the case of ‘Cecil’ aet 21 months at first consultation.
Case XVIII: ‘Mrs X’ aet 30 Years
Authors: Winnicott Donald W.
Published: March 2017

This is case XVIII in part 3 of Winnicott’s book Therapeutic Consultations in Child Psychiatry: the case of ‘Mrs X’ aet 30 years.
The Earliest States
Authors: Winnicott Donald W.
Published: March 2017

In this chapter, Winnicott presents an account, along with a series of diagrams, to describe the earliest states of infancy, including those prior to birth. He postulates an ideal stage of health where internal processes are allowed to evolve while external reality exerts little or no pressure. His diagrams show the isolated individual/infant safe within the mother and as part of her. Small movements by the foetus mean a recognition of the outside-environment mother: coming up against her and discovering her. Equally, any difficulties in the mother can act as environmental impingements on the infant. Winnicott mentions the introduction of the action of gravity after birth and the possibility of a feeling of falling forever if the management of the transition of pre-gravitational to gravitational is handled with clumsiness.
Introduction
Authors: Winnicott Donald W.
Published: March 2017

In this short Preface, Clare Winnicott and Ray Shepherd (Winnicott Publications Committee) prepare the reader for the work by outlining that it is a set of verbatim excerpts from a psychoanalyst’s notes on the treatment of a young child, and that it illustrates Winnicott’s contributions to and understanding of psychoanalysis in the area of child development. It is also described as a lively account of two people working and playing together with enjoyment. These sessions were on the basis of ‘on demand’ treatment, with the collaboration of the child’s parents, and addresses the child’s fears and fantasies, stage by stage, allowing her to progress at her own pace over two and a half years to the satisfaction of all the parties.
First Consultation
Authors: Winnicott Donald W.
Published: March 2017

The second chapter of The Piggle consists of Winnicott’s verbatim report and commentary on the first consultation with Gabrielle and an interview with her mother, 3 February, 1964, and subsequent letters from her father and mother.
Third Consultation
Authors: Winnicott Donald W.
Published: March 2017

The fourth chapter of The Piggle consists of Winnicott’s verbatim report and commentary on the third consultation with Gabrielle, 10 April, 1964, and four letters from her mother.
Seventh Consultation
Authors: Winnicott Donald W.
Published: March 2017

The eighth chapter of The Piggle consists of Winnicott’s verbatim report and commentary on the seventh consultation with Gabrielle, 10 October, 1964, and a letter from her parents.
Ninth Consultation
Authors: Winnicott Donald W.
Published: March 2017

The tenth chapter of The Piggle consists of Winnicott’s verbatim report and commentary on the ninth consultation with Gabrielle, 29 January, 1965, along with two letters from her mother.
Chronological Bibliography of Works by D. W. Winnicott
Authors: Pearn Clay , Adès Robert
Published: March 2017

Winnicott’s complete bibliography of works presented in chronological order.
Remarks on Some Chapters Revised for the Collected Works
Authors: Caldwell Lesley , Robinson Helen Taylor , Adès Robert , Kabesh Amal Treacher
Published: March 2017

Some notes on works which have been revised or edited for the Collected Works.
Selected Signatures
Authors: Winnicott Donald W.
Published: March 2017

A collection of signatures by Winnicott.
The binarity of Galactic dwarf stars along with effective temperature and metallicity
Authors: Gao Shuang , Zhao He , Yang Hang , Gao Ran
Published: March 2017

The fraction of binary stars fb is one of most valuable tools to probe the star formation and evolution of multiple systems in the Galaxy. We focus on the relationship between fb and stellar metallicity [Fe/H] by employing the differential radial velocity (DRV) method and the large sample observed by the Large Sky Area Multi-Object Fiber Spectroscopic Telescope (LAMOST). Main-sequence stars from A- to K-type in the third data release of LAMOST are selected to estimate fb. Contributions to a profile of DRV from the radial velocity (RV) error of single stars σRV and the orbital motion of binary stars are evaluated from the DRV profile. We employ 365 911 stars with randomly repeating spectral observations to present a detailed analysis of fb and σRV in the two-dimensional space of Teff and [Fe/H]. The A-type stars are more likely to be companions in binary star systems than other stars. Furthermore, the reverse correlation between fb and [Fe/H] can be shown statistically, which suggests that fb is a joint function of Teff and [Fe/H]. At the same time, σRV of the sample are fitted for different Teff and [Fe/H]. Metal-rich cold stars in our sample have the best RV measurement.
THE RECOGNITION OF CAVITARY RETINOBLASTOMA TUMORS
Authors: Chaudhry Shabana , Onadim Zerrin , Sagoo Mandeep S. , Reddy M. Ashwin
Published: March 2017

Purpose:

To assess the role of consolidating adjuvant therapy for cavitary retinoblastoma and to understand if there is any phenotype–genotype correlation.

Methods:

Patients with retinoblastomas having ophthalmoscopically visible cavities between 2004 and 2014 in whom 4 to 6 cycles of systemic chemotherapy were given.

Results:

Eighteen eyes of 17 patients displayed cavitary retinoblastomas. This represented 6.8% of 250 patients. Mean age at diagnosis was 13 months; 5 unilateral (29%) and 12 bilateral (71%). The mean (median, range) number of retinoblastoma tumors per eye was 2 (2; 1–6). The number of cavities per tumor was 3 (2, 1–6). Intratumoral cavities were seen in the superficial portion of the tumor in 10 eyes (55%). The cavities became visible in eight eyes (44%) and collapsed in eight eyes (44%). Two eyes required enucleation because of relapse in noncavitary tumors. Germline mutations were detected in 14 patients (82%) of whom four demonstrated mosaicism (29%); only one had a low penetrant mutation. The mean follow-up period was 40 (35, 6–120) months.

Conclusion:

Cavitary retinoblastomas can be detected after systemic chemotherapy with cavities becoming visible after mean two cycles of chemotherapy (secondary cavitary retinoblastoma). The etiology is uncertain. They remain stable and do not require aggressive adjuvant therapy. There was no evident phenotype–genotype correlation with mosaicism noted in 29%.
Validity of the Pediatric Canadian Triage Acuity Scale in a tertiary children’s hospital in Israel
Authors: Allon Raviv , Feldman Oren , Karminsky Anna , Steinberg Carmit , Leiba Ronit , Shavit Itai
Published: March 2017

Objective

In 2015, the Israeli Ministry of Health issued national guidelines demanding the use of a five-level triage system in pediatric emergency departments (EDs). The present study aimed to evaluate the validity of the Pediatric Canadian Triage Acuity Scale (PedCTAS) in the ED of a tertiary children’s hospital in Israel.

Methods

A retrospective cohort study of all patients admitted between January 2011 and December 2015 was carried out. The proportion of hospitalization was the primary outcome measure. The secondary outcomes were proportion of admissions to the ICU, proportions of patients who left without being seen (LWBS), and length of stay (LOS) in the ED.

Results

A total of 83 609 patients were included in our analysis. Triage levels 1–5 included 533 (0.6%), 4428 (5.3%), 46 461 (55.6%), 28 510 (34.1%), and 3677 (4.4%) patients, respectively. Hospitalization proportions were 70, 51, 28, 15, and 12% for triage levels 1, 2, 3, 4, and 5, respectively. Admission proportions to ICU were 24.2, 3.05, 0.24, 0.05, and 0.05% for PedCTAS levels 1, 2, 3, 4, and 5, respectively. The proportions of LWBS were 0.001, 0.002, and 0.005% for triage levels 3, 4, and 5, respectively. LOS was shorter as the triage level increased from 2 to 5.

Conclusion

Triage level was predictive of hospitalization, admission to the ICU, and proportions of LWBS and LOS in the ED. The findings suggest validity of the PedCTAS in this cohort. This is the first report of the performance of a triage tool in an Israeli ED.
The Effect of a Rapid Rehabilitation Program on Patients Undergoing Unilateral Total Knee Arthroplasty
Authors: Pagnotta Geraldine , Rich Ellen , Eckardt Patricia , Lavin Patricia , Burriesci Rachele
Published: March 2017

BACKGROUND:

Few studies have looked at longer term functional outcomes of rapid rehabilitation (physical therapy in the postanesthesia care unit on the day of surgery) for patients undergoing total knee arthroplasty.

PURPOSE:

The purpose of this interdisciplinary study (physical therapy and nursing) was to assess the effect of a rapid rehabilitation program on inpatient length of stay (LOS) and functional recovery.

METHODS:

Functional outcomes were measured by the Knee Injury Osteoarthritis Outcome Score presurgically and at 4 and 12 weeks postoperatively and by progression along a physical therapy rehabilitation pathway.

RESULTS:

Experimental group LOS was significantly shorter than the control group (p = .0261). Multilevel regression modeling showed that KOOS and physical therapy clinical pathway score trajectories did not differ significantly between groups. Patients receiving rapid rehabilitation were 2.5 (95% CI [0.958, 6.53]) times more likely to have a positive physical therapy rehabilitation trajectory than patients in the control group.

CONCLUSION:

Findings validated earlier study results in terms of LOS; however, further research is needed to assess the effect of rapid rehabilitation on longer term functional outcomes.
Early Identification and Treatment of Osteoporosis in a Rural Internal Medicine Clinic
Authors: Jones J. J. , Henry Kristina
Published: March 2017

Osteoporosis affects more than 44 million individuals in the United States annually while disease management continues to fall short of the recommended guidelines. This study institutes a practice change for osteoporosis/osteopenia screening and treatment founded on current evidence-based guidelines. A retrospective chart review was evaluated for current trends in the identification and treatment of osteoporosis/osteopenia in female patients older than 65 years. Data were then compared with identical data collected after implementing an evidence-based osteoporosis guideline tool. Quantitative analysis indicated poor adherence of established osteoporosis guidelines by providers. In comparison, after implementation of the osteoporosis treatment guideline tool, there was an improvement of more than 40% in the identification and treatment of osteoporosis/osteopenia. Utilization of the evidence-based osteoporosis guideline tool resulted in quality improvement in identifying and treating those with or at risk for osteoporosis/osteopenia.
A Diagnostic Algorithm Combining Immunohistochemistry and Molecular Cytogenetics to Diagnose Challenging Melanocytic Tumors
Authors: Redon Sylvia , Guibourg Briac , Talagas Matthieu , Marcorelles Pascale , Uguen Arnaud
Published: March 2017

Some melanocytic tumors are diagnostic challenges and require ancillary tools in helping the pathologists to determine their potential of malignancy. We intend to propose a diagnostic algorithm in helping to classify challenging melanocytic tumors combining histology, immunohistochemistry, and cytogenetics. We report on 24 spitzoid and/or misdiagnosed melanocytic tumors studied with a triple p16, Ki-67, and HMB45 immunohistochemistry score, fluorescent in situ hybridization (FISH) with melanoma-dedicated and non–melanoma-dedicated probes and comparative genomic hybridization on DNA microarray (CGH array). Melanoma-dedicated FISH probe classified as favor malignant 8/8 melanomas, 1/2 atypical spitzoid tumor, and 4/14 nevi with polyploidy. Only 10 CGH array assays were contributive and concluded in complex chromosomal patterns as hallmarks of malignancy in 5 melanomas, single isolated imbalances in 3 nevi, and no chromosomal gain or loss in 2 nevi. The p16-Ki-67-HMB45 immunohistochemistry score was favor benign (ie, 0 to 3) in 13/14 nevi and in the favor benign atypical spitzoid tumor according to FISH analyses. The FISH-favor malignant atypical spitzoid tumor, 8/8 melanomas, and 1 tumor initially diagnosed as a Spitz nevus had favor malignant p16-Ki-67-HMB45 immunohistochemistry scores (ie, 4 to 9). Additional FISH analyses detected a 9p21/CDKN2A double deletion, frequently reported in melanomas but not in nevi, in the tumor initially diagnosed as a Spitz nevus with a favor malignant p16-Ki-67-HMB45 score. To conclude, in our opinion, histology and p16-Ki-67-HMB45 immunohistochemistry could consist in first-line tools to diagnose a difficult melanocytic tumor, followed by cytogenetics analyses in cases of discrepancies between histology and immunohistochemistry.
A Study Comparing Colorectal Cancer Screening Techniques
Authors: Stewart Rachel , Carter-Templeton Heather
Published: March 2017

Colorectal cancer is in the top 3 of both diagnosed cancers and deaths related to cancer in the United States. Despite this, Americans are continuing to forgo colorectal cancer screening as part of their preventive health maintenance. Screening helps identify precancerous and early cancerous lesions so they can be easily treated and cured. The purpose of this study was to compare the rates of detection of adenomatous (precursors to colorectal cancer) polyps and colorectal cancer in 2 groups of asymptomatic patients: one group undergoing standard colonoscopy and the other group undergoing standard colonoscopy in conjunction with fecal occult blood testing. A pilot study was performed using a total of 63 patients who were randomly allocated into 2 groups: those receiving standard colonoscopy as the control group and those receiving standard colonoscopy in conjunction with fecal occult blood testing as the intervention group. Research participants also completed demographic information as well as a survey evaluating their perceptions regarding colorectal cancer screening. This survey was adopted from a previous study that evaluates colorectal cancer disease awareness and patients' perceptions following a Health Belief Model. The results show that despite a detection rate of 41% of adenomatous polyps in the intervention group, there were no positive fecal occult blood testing specimens. The Health Belief Model survey revealed that most participants were appropriately aware of the seriousness and treatability of colorectal cancer. They also agreed that colorectal cancer screening guidelines were important and beneficial to follow.
The Social Stigma Experience in Patients With Hepatitis B Infection
Authors: Valizadeh Leila , Zamanzadeh Vahid , Bayani Masomeh , Zabihi Ali
Published: March 2017

The social stigma in patients with hepatitis B virus infection has caused several complications for both the patients and the associated medical system. This study aimed at demonstrating the social stigma experienced by these patients in Iran. This is a qualitative study using a content analysis approach with references to primary and secondary sources. The data were collected through 15 unstructured and in-depth interviews conducted in 2014. By analyzing the data, two main themes were noted: extrinsic concepts of social stigma (causing reprehension, embarrassment, and discrimination) and intrinsic concepts of social stigma (sense of rejection, isolation, and frustration). The analysis of participants' experiences showed that social stigma is a simple lack of knowledge among the patients and society and it is more intense in the first days after the diagnosis. Stigma is prevalent among patients with hepatitis B virus, causes them to hide the disease, and provokes various complications for them as well as society. This study emphasizes the necessity of implementing health education programs about hepatitis B and its associated stigma, especially considering the potential impact of a mass media campaign.
Health and health care disparities among women in mainland China
Authors: Wang Xiaofei , Lu Jiehua
Published: March 2017

Purpose

Women’s health is considered a big public health issue, impacting personal well-being, family reproduction, and society’s development. Since the foundation of the People’s Republic of China, major improvements in women’s social status and health have been made. However, far less has been achieved with respect to gender equality and women still face health disparities. The purpose of this paper is to provide a better understanding of health and health care disparities among women and their determinants in China today.

Design/methodology/approach

This paper used the Statistical Yearbook of Health and Family Planning 2014, the 2010 Women’s Social Status Survey and 2010 census data from the National Bureau of Statistics to give an overall description of disparity in health care and health outcome facing women.

Findings

Progress in health is not equally shared by the female population, and the differences in women’s health by region and in urban and rural areas are considerable. The existing health disparities are still faced by women in terms of life expectancy, hazardous working environment, and health care services. As to gender differences among the elderly aged 60+, men have better health status compared to women. In addition, women are more financially dependent on other family members for the main source of daily living, reflecting their economic disadvantages.

Originality/value

This study gives a comprehensive and the latest overview of trends of women’s health progress, disparities in health care, and health outcomes both in female population and between genders by using three data sources.
The work-to-life conflict mediation between job characteristics and well-being at work
Authors: Chambel Maria José , Carvalho Vânia Sofia , Cesário Francisco , Lopes Silvia
Published: March 2017

Purpose

The purpose of this paper is to compare part-time and full-time employees, analyzing the relationship between job characteristics and workplace well-being (i.e. burnout and engagement) and the mediating role of the work-to-life conflict with a sample of 736 employees from 14 Portuguese call center companies.

Design/methodology/approach

The hypotheses were tested with multiple group analysis on two samples: part-time and full-time employees.

Findings

The results confirm that in both the part-time and full-time subsamples employees’ perceptions of job characteristics are related to their well-being, and the work-to-life conflict partially mediates this relationship. Moreover, the study confirms that the relationship between employees’ perceptions of job demands and the work-to-life conflict and between the work-to-life conflict and workplace well-being were stronger for full-time than for part-time employees.

Research limitations/implications

The co-relational and cross-sectional design should be regarded as limitations. Moreover, each variable was only assessed with self-reported measures, and the sample comprised call center employees from only one country (Portugal), which may constrain the generalization of these results.

Practical implications

Part-time work is a good solution in order to prevent the work-to-life conflict. Furthermore, a reduced workload and time pressure, enhanced decision latitude and supervisory support appear to be crucial work characteristics for employees juggling their work with other roles and in the promotion of well-being at work.

Originality/value

This research study provides evidence that the traditional vision of the work-family conflict requires a broader conceptualization by considering the interference between life roles, particularly in the case of full-time young employees.
Stories of a transformative mentorship: graduate student glue
Authors: Scott Chyllis E. , Miller Diane M.
Published: March 2017

Purpose

The purpose of this paper is to narrate authors’ personal and professional experiences as doctoral graduate students, highlighting the personal and academic growth fostered through an organic peer mentorship and advocating that these relationships be cultivated actively by faculty advisors.

Design/methodology/approach

The concepts of purpose, planning, and positivity are employed to organize the discussion, which is based on relevant literature and the authors’ lived experiences.

Findings

Like most students who pursue and complete doctoral degrees, the authors experienced transformative learning. The authors acknowledge myriad ways their informal peer mentoring relationship was a critical component of successful degree completion.

Originality/value

While their relationship remains unique and perhaps inimitable, the authors seek to extrapolate the universal qualities relevant to others seeking a deep and personal support system during their doctoral degree-seeking journey.
An electronic referral system supporting integrated hospital discharge
Authors: Wilberforce Mark , Hughes Jane , Clarkson Paul , Whyte David , Chester Helen , Davies Sue , Challis David
Published: March 2017

Purpose

The purpose of this paper is to evaluate the implementation and potential value of an electronic referral system to improve integrated discharge planning for hospitalised older adults with complex care needs. This new technology formed part of the “Common Assessment Framework for Adults” policy in England.

Design/methodology/approach

Mixed methods were undertaken as part of a case study approach within an acute hospital in the North West of England. First, qualitative interviews were undertaken with practitioners to explore early experiences using the new technology. Second, routinely collected administrative data were analysed, comparing referrals made using the new technology and those made through the usual paper-based process.

Findings

Qualitative interviews found that an electronic discharge system has, in principle, the potential to improve the efficiency and suitability of integrated care planning. However, the implementation proved fragile to decisions taken elsewhere in the local care system, meaning its scope was severely curtailed in practice. Several “socio-technical” issues were identified, including the loss of valuable face-to-face communication by replacing manual with electronic referrals.

Research limitations/implications

The small number of patients referred during the implementation phase meant that patient outcomes could not be definitively judged. Research into the longer-term implications and value of electronic referral systems is needed.

Originality/value

There is concern that attempts to integrate health and social care are stymied by incompatible systems for recording service user information. This research explores a novel attempt to share assessment information and improve support planning across health and social care boundaries.