Entrenched grievance as a harbour for the unmourned.

This paper hopes to enhance understanding about entrenched grievance in a couple of ways: (a) Initially, the paper reviews how entrenched grievance reflects melancholic states of mind in terms of its avoidance of the pain of loss and change. But the main contribution of the paper is likely to be found in (b), that is, via detailed clinical material, the paper illustrates how earnest efforts on the part of the analyst to bring understanding may lead to cognitive entrapments such as the convictions incumbent in the "knowing" analyst. Further, that this knowing analyst may need to become aggrieved, that is, narrow, impatient and concrete towards her patient's entrenchment, and then to recogize this plight in herself before she can genuinely hear her patient's grievance about her from a wider view, that is as a complaint from the "lively self", deserving recognition. The clinical detail demonstrates that such recognition softened the patient's grievance, allowing both members of the dyad to become more collaborative and open to the pains and growth available from mourning states of mind.

Effect of Cardiac Surgery on Health-Related Quality of Life in Patients Aged 75 Years or Older: A Prospective Study.

BACKGROUND: Health-related quality of life (HRQoL) of patients, aged 75 years or older, was measured before and at 12 weeks after cardiac surgery using a generic tool (SF12 version 2). METHODS: This was a single centre, prospective study of patients aged 75 years or older who had any type of cardiac surgery. The instrument was self-administered preoperatively and by interviewer administered via telephone at 12 weeks. RESULTS: Sixty-six (66) of the 81 participants approached were eligible and agreed to participate. Mean age was 79.2 years, 17 participants were female (25.8%), 56 participants were New Zealand European (84.8%) and the mean Euroscore II score was 4.0. Sixty (60) participants (90.9%) provided data at follow-up. All mean HRQoL domain scores significantly improved by 12 weeks after surgery. The pattern of gain was similar for ages 75-79 and 80 years and older. The changes in the physical and mental component summary (PCS, MCS) scores were statistically significant and the mean scores were proximate to or better than age group norms at 12 weeks. The number of patients with a PCS score at or above age group norms improved from 16.4% to 56.6% while the number of patients whose MCS scores were at or above age group norms improved from 55.7% to 81.6%. Health utility values also significantly improved. CONCLUSIONS: Cardiac surgery in older patients is associated with significantly improved physical and mental health-related quality of life at 12 weeks after procedure.

Implementing a prescribing practicum within a Master's degree in advanced nursing practice.

The recent introduction of Nurse Practitioner registration in New Zealand has resulted in the development of a number of Master's degree programmes in which students focus clinically and can complete a Nursing Council of New Zealand approved programme for prescribing. This article reports the implementation of a collaborative project undertaken to monitor and improve the effectiveness of the prescribing practicum papers delivered within two Master's degree programmes in advanced nursing practice. A developmental action research approach was used. Data were collected through interviews with practicum students, their medical supervisors and academic staff. Formative findings were progressively used to refine delivery of the practicum papers and a thematic analysis of summative findings identified areas for further improvement. The findings suggest that the processes being implemented are developing well. Further education is required to clearly differentiate medical and advanced nursing roles. Greater attention needs to be paid to the preparation of medical supervisors and, most significantly, revision of funding is required to more equitably support the ongoing development of nurses for advanced practice roles.

The death of a mind: a study of Shakespeare's Richard III.

Some of the most difficult aspects of our work involve our encounters with states of mind which are steeped in and spread violence. In these circumstances, we experience our best efforts to offer empathic presence and thought to avoid being assaulted and obliterated. In these instances, a figure from literature depicting the details in question may come to our aid. In the play popularly known as Richard III,William Shakespeare depicts how the state of mind which is etched by grievance and committed to revenge may impose the 'winter of (its) discontent' upon the sunny dispositions of others' healthy, integrated functioning. Shakespeare masterfully depicts Richard's cunning and malice, but he also illustrates how this vengeful state uses guile and 'changes of shape' to seduce its way past protective boundaries, utilizing the human qualities of trust, open-heartedness and longing as pathways for invasion, betrayal and emotional devastation. This paper will view excerpts of the play's text from a psychoanalytic perspective which suggests that several clear lessons about this obliterative state of mind may be gleaned: that grievance can only operate to spread grievance and destruction; that our open-hearted and trusting qualities do make us vulnerable to such invasion and betrayal, but that our humanity is also the only avenue for rescue from this plight. In addition a clear lesson is offered about the value of protected 'sanctuary', that is, mental space where our most potent tool in these circumstances, our discerning minds, might find residence.

Evaluation of bioflavonoids as potential chemotherapeutic agents.

Bioflavonoids are compounds that are natural plant antioxidants. Antioxidants have been shown to prevent damage caused by free radicals to DNA and other molecules. Bioflavonoids have demonstrated several cancer preventive properties. In addition to antioxidant activity, these compounds may reduce abnormal cell growth and inflammation; help the body get rid of cancer-causing agents; and restore communication between different cells in the body. The objective of this study is to compare nontoxic phenols as cancer chemotherapeutic, agents and to apply these agents in treating human cancers. In this study the effects of a single dose of 10 microM Green Tea Extract (EGCG), 5 microM Tannic Acid (TA), or 5 microM Thymoquinone (TQ) on Hep-2 cells were determined. Compounds were evaluated in their effectiveness to reduce cell number. The cells were also evaluated for membrane damage, and alterations in cellular morphology after 24, 48, and 72 hours in culture. The results showed a 50% reduction in Hep-2 cell numbers after 24 hours in TQ treated cells. After 48 hours, the cells treated with TQ and TA exhibited a four-fold decrease in total cell number compared to the control and EGCG treated cells. Cell numbers were similar in all treatment groups by 72 hours. At 48 hours the only significant increase in cell damage was seen in cells treated with EGCG. The results indicated that naturally occurring bioflavonoids given in a bolus dose could alter cellular viability. It appears the drug is either utilized by the cells or chemically degraded in the media leading to increased cell numbers back toward control values with time in culture. In order for the compounds to be effective chemotherapeutic agents, the data also suggests a need for continuous administration over bolus dosing.