No abstract

No abstract

Many psychotherapists cry in therapy sessions. Those clinicians who do cry see it as likely to have a positive impact on the therapy or to have no impact, and therapist personality characteristics have not shown reliable associations to crying in therapy. However, it is not known how patients experience therapists' crying, or whether the patient's view of the therapist's characteristics is related to that experience. This study used an online survey, recruiting 202 patients with eating disorders, 188 of whom had received therapy for an eating disorder, and 105 of whom had experienced a therapist crying. Retrospective data from those 105 individuals indicated that therapists' crying tended to be seen positively, but that perception was influenced by the patients' perceptions of the demeanor of their therapist and their understanding of the meaning of the crying. While they need to be extended to other disorders, these findings suggest that therapists' crying needs to be understood in the context of the therapist's perceived characteristics and demeanor, rather than being assumed by therapists to be positive or to have no impact on the therapy.Keywords: Psychotherapy; therapist; patient; crying IMPACT OF CLINICIANS' CRYING 3 Patients' Experiences of Clinicians' Crying during Psychotherapy for Eating DisordersPsychotherapy has a tradition of focusing on the inner world of the patient. However, the inner world of the therapist is also important, as it interacts with that of the patient. Such interaction appears in many forms in the literature, including constructs such as transference/countertransference and the therapeutic alliance. Therefore, regardless of therapeutic orientation, it is important to consider the therapist's reactions to the client during the session (e.g., Gelso & Hayes, 2007;Gilbert & Leahy, 2007;Summers & Barber, 2010).This study addresses one specific reaction -the therapist crying in the session, and the impact of that experience on the patient.Emotional experience in the therapy session and how it can disrupt therapy if unattended are key elements of therapists' reactions. This concept is not limited to the psychodynamic construct of countertransference. For example, Waller (2009) has hypothesised that cognitive-behavioral therapists who experience higher levels of anxiety are less likely to implement core behavioral techniques, making them less effective.Following a series of small-scale reports in the literature, Blume-Marcovici, Stolberg and Khademi (2013) surveyed a large number of psychologists and trainees (N = 684) regarding one specific emotional marker -the therapist crying in therapy. In this relatively diverse group of clinicians, using a variety of therapeutic approaches with a wide range of patients, they reported that over 70% of the therapists reported ever having cried in therapy (with 30% having done so in the past four weeks). Pope, Tabachnick and Keith-Spiegel (1987) found a slightly lower lifetime rate for therapists' crying (56.5%), but these findings represent a ...

Objective To evaluate whether outpatient treatment of periorbital cellulitis with daily administration of intravenous antibiotics and physician evaluation is an effective and safe alternative to admission. Design A retrospective chart review study of paediatric patients treated on an outpatient basis for periorbital cellulitis at a tertiary children's hospital between 2013 and 2015 was performed. Children were assessed day by a paediatrician to monitor for resolution of symptoms or complications. Setting The Montreal Children's hospital, a tertiary care centre. Participants Children diagnosed with an uncomplicated periorbital cellulitis secondary to an acute sinusitis or upper respiratory tract infection. Main outcome measures The number of days of intravenous antibiotics, complications or need for subsequent admission. Complications were defined as formation of an abscess or phlegmon confirmed on computerised tomography scan, worsening or recurrent persistent cellulitis, failure to improve on intravenous antibiotics, and intracranial complications. Results Sixty‐six children with a diagnosis of uncomplicated periorbital cellulitis secondary to sinusitis who received intravenous antibiotics via medical day hospital and who fit the inclusion criteria were identified. The mean duration of intravenous antibiotic therapy was 4.1 days. All children received ceftriaxone, with one patient also receiving cefuroxime. Two of 66 patients developed complications; one patient required admission for failure to improve/subperiosteal phlegmon and later underwent functional endoscopic sinus surgery, and one patient developed an eyelid abscess that did not require admission. No patients developed severe neurological or visual deficits. Conclusions Outpatient intravenous therapy with daily reassessment by a physician may be a safe alternative to admission in select cases of periorbital cellulitis without systemic signs of illness.

In vitro tests have shown to be helpful in the diagnosis of betalactams (BL) hypersensitivity, being immunoassays the most widely used. Our aim was to compare sensitivity, specificity, positive and negative predictive value (PPV and NPP) of both immunoassays in the diagnosis of BL hypersensitivity. METHODS: We included 37 patients with confirmed immediate hypersensitivity to penicillin/amoxicillin by basophil activation test (BAT), skin tests (ST) and/or drug provocation test (DPT). ImmunoCAP and RAST were performed with penicillin and amoxicillin in all patients as well as in 20 tolerants to BL. RESULTS: Comparing RAST and CAP, sensitivity was higher for RAST (67% vs 15.7%, p<0.0001) whereas specificity was higher for CAP (100% vs 50%, p50.0002). Sensitivity was higher for RAST compared to CAP considering both penicillin (9% vs 0%, p>0.05) and amoxicillin (61% vs 15.7%, p<0.0001). PPV was higher for CAP compared to RAST (100% vs 81%, p>0.05), whereas NPV was higher for RAST than for CAP (34% vs 21%, p>0.05). A concordant result between the two assays was found in 16 cases (43.24%: kappa50.27), which represents a fair level of agreement. RAST was positive in 75% of patients with negative ST, thus by combining RAST and ST we can diagnose 91.8% of patients with immediate hypersensitivity to BL. CONCLUSIONS: Immunoassays represents useful complementary tools for diagnosing HRs to BL, being RAST more sensitive than CAP. When combined RAST with ST, we can diagnose correctly most of patients with immediate hypersensitivity to BL.