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In this paper some basic concepts of Digital Image processing are presented, such as image enhancement and segmentation, and some of the activities in Medical Imaging of the Image Processing group of the University of Aveiro/INESC are described.
Autogenic training in the GDR is the most frequently employed psychotherapeutic method, mostly as a symptom-centred procedure in neurotic reactions and beginning secondary faulty psychic development, but also in neurotic reactions on the basis of primary faulty development. These facts in particular oblige us to practise autogenic training in a methodically clean manner. This is done by us in the form of closed groups. This paper is intended to give some aspects of the group process under special consideration of the therapist/patient relation and some risks and degeneration possibilities of these processes.
A range of joyful emotions may be woven into the therapeutic group process for older persons. Experiencing joy is a powerful healing factor because it helps reduce the pain of losses inherent in the aging process, restores self-confidence and hope, and renews an investment in living. This paper identifies ten facets of joy which can help develop a therapeutic group climate. Examples from the authors' practice illustrate conceptual approaches.
This case study demonstrates that team development takes time. It involves interpersonal skill development for staff members, management training, and specific team building sessions after the teams form. It is crucial that the specific content of training for managers, staff members, team leaders, and team members evolves from an assessment of organizational needs coupled with involvement of all levels of the department. You may ask if this entire process has made a difference. Yes, it has. Staff members are beginning to be more open and honest with one another regarding issues detrimental to the group process. Above all, team leaders and staff are assuming responsibility together for the workload and process improvement. Implementing the team process without proper training and assessment is sure to fail. Yet we must continue to work and shape the team process toward the final level of self-direction.
OBJECTIVE: To determine the efficacy of imagery for influencing attitudes and moods in multiple sclerosis patients. DESIGN: Experimental pretest-posttest, control-group. SETTING: Outpatient group in Central Pennsylvania. PATIENTS: 33 patients with mean ages of 43.93 years in the imagery group and 46.33 years in the control group. All subjects previously were identified with multiple sclerosis. INTERVENTION: Control group subjects followed their typical medical protocol and completed pretest and posttest measures. Imagery group subjects completed pretest and posttest measures and participated in a six-session group process that included brief exposure to relaxation training and ongoing work with biologically oriented imagery. Relaxation training and imagery were practiced on a daily basis. Imagery group subjects also produced imagery drawings, which were assessed after the third and sixth sessions. MAIN OUTCOME MEASURES: Profile of Mood States, State-Trait Anxiety Inventory, Health Attribution Test, Imagery Assessment Tool, and Multiple Sclerosis Symptom Checklist. MAIN RESULTS: Imagery group subjects demonstrated significant reductions in state anxiety and significant alteration in their illness imagery because of feedback obtained during the study. CONCLUSION: Use of the relaxation/imagery protocol led to clinically significant reductions in state anxiety. Imagery may be assessed through drawings that allow for positive modification of the imagery material to increase its utility and power.
Preliminary research in the treatment of obesity suggests that group interventions may be at least as effective as individual interventions, presumably due to the social support created among individuals in the group. Given that a cost-effectiveness analysis may favor groups, further research is necessary on how the benefits of group process can be maximized.
The purpose of this study was to investigate how underlying cognitive deficits such as a defect in processing speed or in selective attention contributed to different types of memory impairment observed in schizophrenia (superficial vs deep encoding). 49 schizophrenic patients and 40 normal controls were administered a verbal memory task. Superficial encoding was assessed by the ability to recall items in their serial order. Deep encoding was assessed by the ability to organise words into semantic categories. Two measures of processing speed (Digit Symbol Substitution Test and Stroop colour time) and one measure of selective attention (Stroop test) were used. Regression analyses were carried out. In the patient group, processing speed contributed to both superficial and deep encoding, and to a global verbal memory score. Selective attention only contributed to the superficial encoding processes. Thus, slowing of processing speed in schizophrenia seems to be more crucial for memory performance, since it affects memory in a pervasive way.
PURPOSE: To evaluate the autofluorescence images of patients with nonexudative and the fellow eyes with exudative age-related macular degeneration (AMD). DESIGN: Observational case series. PARTICIPANTS: Fifty-four patients seen in the author's practice. METHODS: A fundus camera-based system for autofluorescence photographs was used, and the wavelengths for the excitation (580 nm) and barrier (695 nm) filters were based on known transmission and autofluorescent characteristics of the ocular media. Patients were also photographed with red-free and infrared monochromatic imaging. The mean levels of autofluorescence were compared between patients without (group 1) and those with exudative AMD. Comparisons were made among patients with exudative AMD, examining the autofluorescence pattern in those without retinal vascular contribution to the exudative process (group 2) to those with retinal vascular contribution (group 3). MAIN OUTCOME MEASURES: Mean amounts and patterns of autofluorescence. RESULTS: A total of 54 patients was evaluated; 18 were in each group. The mean age was 75.4 years, and there was no difference in the mean ages among the groups (P = 0.16). There was no correlation of the autofluorescence measurements and the degree of nuclear sclerosis (P = 0.14). Patients with exudative AMD had more autofluorescence in the fellow eye than did eyes of patients without exudative AMD (P = 0.002). Patients in group 3 were more likely to have focal hyperpigmentation, particularly as imaged by infrared light (P = 0.015), and focal areas of intense autofluorescence (P = 0.001) than were patients in group 2. CONCLUSIONS: By use of this method of autofluorescence imaging, it was determined that the fellow eyes of patients with exudative AMD had larger amounts of autofluorescence than did the eyes of patients without a history of exudative AMD. Patients with retinal vascular anastomosis to the vascular proliferation of exudative AMD were much more likely to have focal areas of intense autofluorescence in their fellow eye that corresponded, for the most part, with focal areas of hyperpigmentation best seen by infrared monochromatic fundus photography. Because the amount of fluorescence is directly related to the amount of lipofuscin, which in turn is related to the cumulative amount of oxidative damage, these findings suggest possible explanations for certain patterns of vessel growth seen in exudative AMD.
In community-based alcoholism and drug abuse treatment programs, the vast majority of interventions are delivered in a group therapy context. In turn, treatment providers and funding agencies have called for more research on interventions delivered in groups in an effort to make the emerging empirical literature on the treatment of substance abuse more ecologically valid. Unfortunately, the complexity of data structures derived from therapy groups (because of member interdependence and changing membership over time) and the present lack of statistically valid and generally accepted approaches to analyzing these data have had a significant stifling effect on group therapy research. This article (a) describes the analytic challenges inherent in data generated from therapy groups, (b) outlines common (but flawed) analytic and design approaches investigators often use to address these issues (e.g., ignoring group-level nesting, treating data from therapy groups with changing membership as fully hierarchical), and (c) provides recommendations for handling data from therapy groups using presently available methods. In addition, promising data-analytic frameworks that may eventually serve as foundations for the development of more appropriate analytic methods for data from group therapy research (i.e., nonhierarchical data modeling, pattern-mixture approaches) are also briefly described. Although there are other substantial obstacles that impede rigorous research on therapy groups (e.g., evaluation and measurement of group process, limited control over treatment delivery ingredients), addressing data-analytic problems is critical for improving the accuracy of statistical inferences made from research on ecologically valid group-based substance abuse interventions.
Quality of life is a concern for people living with diagnoses of persistent mental illness. While some studies with this community of people have measured quality of life as an indicator of adjustment, little is known about the meaning of quality of life from the perspectives of these individuals themselves. The project described in this practice column explored the meaning of quality of life for a group of persons attending a community centre for persons with mental illness. Parse's human becoming practice method was used to guide the group process with eight men who met weekly with a nurse for 75-90 minute sessions over 10 weeks. The nurse's commitment to live true presence with the group enabled their expressions about life and the meanings of living with their particular struggles and joys, sufferings and hopes. Themes of quality of life for this group of persons are detailed in this column.
This article explores the hidden somatic passions that get laid down in the earliest bad fits (i.e., misattunements) and become the source of the highly resistant narcissistic behaviors that support and concretize one's identity. The omnipotent child syndrome is used to define these passionate, somatic, psychic attachments. The "Omnipotent Child," as I call it, is that part of the internal psychic structure that is the final common pathway of all the passionately held bad fits that characterize not only the person's object ties and attachments, but also his or her most powerful internal psychic identity. The importance of the exploration and elucidation of preverbal experiences in the group are crucial to the unfolding of these unhealthy attachments. Recent infant research, coupled with neurobiological advances, supports the idea of the formation for these attachments. The author explores the theoretical underpinnings of this syndrome through case examples of the omnipotent child in the group process.
Educating the general population and health care workers about the acquired immunodeficiency syndrome (AIDS) is of paramount importance. There is a need to address the many fears and anxieties concerning this dreaded illness. Experience has shown that simple information-giving alone does little to allay the panic in the general population and in hospital personnel. The paper offers a psychodynamic explanation of the origins of the irrational fear and anxieties around AIDS patients and why information alone does not help the anxieties hospital workers experience. We have suggested a training program using group process and videotape techniques which can address the underlying fears and concerns about AIDS patients. These sessions can help hospital staff to deliver more empathic care to this patient group.
The most important basis for evaluating an assistive device is whether it satisfies the needs of the disabled consumer. However, the factors that consumers consider in determining whether a device meets their needs are not well understood. This preliminary study applied a small focus group process to identify and prioritize factors used by long-term users of assistive technology in assessing their devices. A modified version of the Delphi Method was applied to two groups of long-term users--a Panel of Consumer Experts with Mobility Impairments and a Panel of Consumer Experts with Sensory Impairments. In total, the panels identified and prioritized 17 general factors for 11 types of assistive technologies. This study constitutes an initial step toward the development of design, engineering, and selection criteria based on the specific concerns of consumers.
Promoting HMOs as part of a national health strategy began in 1971. An analysis of the data that have been accumulated in the intervening years sheds new light on the issues raised during the legislative hearings prior to the HMO Act of 1973. It describes the developmental process of the HMO program and suggests procedural modifications. It illustrates the difficulty of determining HMO viability during the early stages of operation, examines the varied hospital utilization rates of prepaid group practices and individual practice models, and suggests a hypothesis based on the dynamics of group process and peer pressure for HMO provider behavior.
Circadian feeding rhythms have been revealed in several fish species, but whether or not social interactions influence the expression of the rhythms remains largely unexplored. This paper reported such an exploration in rainbow trout. The experiment was conducted in two consecutive stages in two adjacent insulated rooms. In Stage 1, 40 fish (146.0+/-21.7 g, mean+/-S.D.) were held individually in Room 1. In Stage 2, those 40 fish from Room 1 were distributed into eight groups of five fish according to their previous circadian properties and placed in Room 2. Isolated trout were generally diurnal feeders, but variability among the individuals was evident, with five types of diurnal self-feeding pattern being detected. The influence of social interactions on diel self-feeding pattern in a group was found to be temporary and reversible. The grouping process did not necessarily enhance the expression of circadian self-feeding rhythms, and the dominant individual(s) did not determine the properties of circadian self-feeding rhythms in the group.
PURPOSE AND OBJECTIVES: The purpose of this study was to use a collaborative process between Advanced Practice Nurses and a nurse researcher to identify barriers to incorporating sexuality assessment and counseling into nursing practice. DESIGN/APPROACH: This article provides an historical account of the collaborative group processes leading to the development and testing of the Sexuality Attitudes and Beliefs Survey (SABS). BACKGROUND/RATIONALE: Nurses often are called upon to talk to patients about their sexuality and sexual concerns. Many nurses believe that sexuality assessment, evaluation, and counseling is a part of their professional role, however, nurses do not necessarily integrate this awareness into their patient care. Discomfort, embarrassment, or strongly held attitudes about the nurse's role in discussing sexuality with patients can act as barriers to responding to these patient concerns. SETTING: A Midwestern urban healthcare facility, affiliated with a university served as the setting. SAMPLE: : Thirty-five nurses working outpatient and inpatient settings in oncology and HIV/AIDS. METHOD: Instrument development and voluntary survey. OUTCOMES: The collaborative initiative developed and piloted an instrument to measure nurses' attitudes and beliefs about human sexuality. Results of the pilot study suggest that what nurses believe patients expect from them, time availability, and confidence in one's ability to address issues related to human sexuality present significant barriers to incorporating sexuality assessment and counseling into nursing practice. CONCLUSION: Successful collaboration among clinicians and researchers required administrative support as well as a individual commitment and is a model that can be adapted to other settings and for other projects. IMPLICATIONS FOR PRACTICE: This study highlights the benefits of collaboration between clinicians and researchers to support evidenced based practice. The findings from this study will be used to develop strategies for removing barriers to sexuality assessment by nurses.
Although this paper has focussed on ways in which group-therapy experience differs from the experience of individual therapy for the beginning therapist, all of the differences discussed are only matters of degree and thus are important in both individual and group therapy. Group-therapy experience tends to enhance the visibility of important aspects of all forms of psychotherapy and therefore should be looked at as a useful tool in learning all forms of psychotherapy. Experience in group psychotherapy should ideally precede or occur simultaneously with initial exposure to individual therapy rather than following afterwards as an option, as is usually the case in current psychotherapy training programs. The most important skill to acquire in learning psychotherapy is the sophisticated ability to listen. To do so involves attending to content, affect, the patient's and one's own verbal language, body language, and meta-communications, conscious as well as unconscious. Group psychotherapy experience early in one's development as a psychotherapist can be a powerful tool in developing this ability to listen. Being part of the group process allows a unique level of intimacy that is probably more equal and vulnerable than in other forms of therapy. The use of the self, and the ability to trust in the process without using theory as a barrier between ourselves and our patients, but rather as a bridge to greater understanding, can all flow from the unique experience of leading a psychodynamic group.
RATIONALE, AIMS AND OBJECTIVES: Clinical practice guidelines have become a standard way of implementing evidence-based practice, yet research has shown that clinicians do not always follow guidelines. METHOD: As part of a larger study to test the effects of an intervention on provider adherence to ischaemic heart disease (IHD) guidelines, we conducted five focus groups at three Veterans Administration Medical Centers with 32 primary care providers, cardiologists, and internists to identify key barriers and facilitators to adherence of the guidelines. Using content analysis, responses were grouped into categories. RESULTS: The main perceived advantages of using the IHD guidelines were improvements in quality and the cost of care. Perceived barriers were the lack of ability of guidelines to manage the care of any one individual patient, the difficulty of accessing guidelines, and high workloads with many complex patients. While providers agreed on the benefits of aspirin, beta-blockers and angiotensin converting enzyme inhibitors, barriers for use of these medications were lack of consensus about contraindications, difficulty in providing follow-up during medication titration, and lack of patient adherence. Sources of influence for guideline use were: professional cardiology organizations, colleagues, mainly cardiologists, and key cardiology journals. However, most providers acknowledged that following guidelines was a personal practice decision. CONCLUSIONS: While results validated the influences of using clinical practice guidelines, our results highlight the importance of ascertaining guideline-specific barriers for building effective interventions to improve provider adherence. An advisory panel reviewed results and, using a modified nominal group process, chose implementation strategies targeting key barriers.