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Play diagnosis and play therapy.

Play therapy used in a family psychiatric unit in England is described, together with an evaluation of its treatment value and its usefulness toward a diagnosis. Individual play techniques are explored, and two case histories are given as examples of how the occupational therapist works with the child, the family, and other practitioners.

Child↗

Moving from parallel play to team play.

Changes in the reimbursement of health care services have required provider systems to become leaner and more attuned to point-of-service demands. As a result of these accommodations, working relationships among the various health care professionals and para-professionals have been altered. The Cleveland Clinic Foundation is not immune to these modifications, thus, the ability to work as a team is now a requisite skill for all those involved in patient care. Although the premise of teamwork is an accepted concept among health care professionals, the reality is that they really work more in a parallel play understanding. This article discusses the competencies needed by nurse managers to lead health care teams and the education provided to assist them to move health care professionals from this parallel play to a team approach to patient care.

Communication↗

Who plays the client? Collaborating with theater departments to enhance clinical psychology role-play training exercises.

This article offers a description of a student-active method of teaching clinical psychology applications, such as interviewing and psychotherapy, that involves collaboration between psychology and theater departments. Clinical psychology instructors recruit theater students to play the client roles in live dyads with the instructors or other students. These dyads may take place during or outside of class and may be videotaped for use in other educational settings. Practical and logistical issues are discussed, and empirical data are presented to demonstrate the effectiveness of this method.

Art↗

Playing patient, playing doctor: Munchausen syndrome, clinical S/M, and ruptures of medical power.

This article deploys sadomasochism as a framework for understanding medical practice on an institutional level. By examining the case of the factitious illness Munchausen syndrome, this article analyzes the operations of power in the doctor-patient relationship through the trope of role-playing. Because Munchausen syndrome causes a disruption to the dyadic relationship between physicians and patients, a lens of sadomasochism highlights dynamics of power in medical practice that are often obscured in everyday practice. Specifically, this article illustrates how classification and diagnosis are concrete manifestations of the mobilization of medical power.

Antisocial Personality Disorder↗

The influence of game duration and playing position on intensity of exercise during match-play in elite water polo players.

In this study, we assessed exercise intensity in 20 water polo games of different duration. The hypothesis that right wing players perform at a higher intensity than back and forward central players was also tested. Thirty water polo players, equally split between three field positions, participated in the study. Initially, their performance-related physiological capabilities were evaluated. Subsequently, during water polo games of short (4 x 7-min periods) or long duration (4 x 9-min periods), heart rate was monitored continuously and blood lactate concentration was measured at the end of each period. Activity patterns were also recorded using a video camera. Mean heart rate over the entire game was 156 +/- 18 beats x min(-1). Overall exercise intensity fluctuated around a value corresponding to the lactate threshold (4.03 +/- 0.96 mmol x l(-1), 86 +/- 5% of peak heart rate) and decreased (P < 0.003) with game time (4.22 +/- 1.8 and 3.47 +/- 1.9 mmol x l(-1) in the second and fourth quarter, respectively). During the last 6 min, heart rate was higher (P < 0.001) in games of short duration (156 +/- 3 beats x min(-1)) than in games of long duration (152 +/- 8 beats x min(-1)). Video analysis showed that the percentage of time spent in low-intensity activities (i.e. "out of game") was lower (23 vs. 26%), whereas that in high-intensity activities (i.e. "sprinting crawl") was higher (21 vs. 19%), in games of short compared with long duration. No difference was observed among players of various field positions in any of the variables examined. Thus during match-play, games of long duration produced significantly lower heart rate responses than games of short duration, and the physiological response exhibited by the players was not affected by field position. The water polo authorities should consider these results before changing game duration and coaches should prepare their athletes accordingly.

Adult↗