Personal Projects Analysis as an idiographic approach in psychotherapy: an exploratory study.

Client feedback research is a new but encouraging area that recognizes the importance of engaging patients in offered treatments and the relevance of the relationship between therapist and client. This study aimed to explore clients' experiences of goal-oriented work using Personal Projects Analysis (PPA). PPA was applied to 5 participants of a psychodrama group after their consent and in agreement with the ethics and deontology research university committee. Their progress was evaluated with Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM; 4 moments) and subjective well-being measures. Findings show how personal projects may be informative about clients' difficulties and change processes. All outcomes on CORE-OM went below clinical cut-off points, and all these changes are reliable and clinically significant. PPA offers a consistent way to implement the goals approach in a psychotherapeutic context successfully. Nevertheless, some adjustments need to be implemented in the goal-oriented work using PPA.

Análise das qualidades psicométricas da versão portuguesa do Inventário de Avaliação da Espontaneidade (SAI-R) / Analysis of the psychometric qualities of the portuguese version of the Spontaneity Assessment Inventory (SAI-R) / Análisis de las cualidades psicométricas de la versión portuguesa del Inventario de Evaluación de la Espontaneidad (SAI-R)

A espontaneidade e as suas ligações à saúde mental e ao bem-estar são uma componente central quer na teoria quer na prática do psicodrama, e a literatura especializada associa a presença de patologia à falta de espontaneidade. Neste artigo, elencam-se alguns dos resultados obtidos em estudos em língua inglesa do SAI-R e apresentam-se os estudos da sua validação para a população portuguesa. Na validação do SAI-R para o contexto português, foi confirmada a estrutura fatorial com 719 sujeitos, distribuídos em duas amostras independentes. Os participantes tinham idades entre os 18 e os 69 anos. Por fim, foram testadas a fiabilidade compósita e a validade convergente, bem como a validade do tipo critério em duas amostras independentes (n 1ªamostra =348 e n 2ªamostra =371). Apesar de serem necessários mais estudos com populações clínicas, o SAI-R apresenta-se como um instrumento curto e válido para aplicar em contextos clínicos e não clínicos quando se pretende avaliar a espontaneidade (AU).

Spontaneity and its connections to mental health and wellbeing are a central theme in both the theory and practice of psychodrama, and the specialized literature sometimes even associates the presence of pathology with a lack of spontaneity. In this article, we list some of the results obtained in studies with the English-language version of the spontaneity scale and present its validation studies for the Portuguese population. We verified a factorial structure with 719 subjects, divided into two independent samples in the validation of the SAI-R for the Portuguese context. Participants had an age range of 18 to 69 years old. Furthermore, composite reliability, convergent validity, and cross validity were tested in two other independent samples (n sample1 =348 and n sample2 =371). Although further studies with clinical samples are needed, the SAI-R presents itself as a short and valid instrument to apply in clinical and non-clinical settings when assessing spontaneity (AU).

La espontaneidad y sus vínculos con la salud mental y el bienestar son una componente central tanto en la teoría como en la práctica del psicodrama, y la literatura especializada asocia la presencia de patología con la falta de espontaneidad. En este artículo se enumeran resultados obtenidos con la versión inglesa del SAI-R y se presentan estudios para su aplicación en la población portuguesa. En la validación del SAI-R para el contexto portugués, se confirmó la estructura factorial con 719 sujetos, distribuidos en dos muestras independientes. Los participantes tenían entre 18 y 69 años. Finalmente, se probaron la confiabilidad compuesta y la validez convergente, así como la validez cruzada en las dos muestras independientes (n muestra 1 = 348 y n muestra2 = 371). Aunque son necesarios más estudios con poblaciones clínicas, el SAI-R se presenta como un instrumento breve y válido para ser aplicado en contextos clínicos y no clínicos en la evaluación de la espontaneidad (AU).

Prevalence and Risk Factors for Augmented Renal Clearance in a Population of Critically Ill Patients.

BACKGROUND: Critically ill patients show a high, albeit variable, prevalence of augmented renal clearance (ARC). This condition has relevant consequences on the elimination of hydrophilic drugs. Knowledge of risk factors for ARC helps in the early identification of ARC. The aims of this study were evaluation of (1) risk factors for ARC and (2) the prevalence of ARC in critically ill patients over a period of 1 year. METHODS: A retrospective cohort study was performed for all consecutive patients admitted to our intensive care unit (ICU). Augmented renal clearance was defined by a creatinine clearance ≥130 mL/min/1.73 m2. "Patient with ARC" was defined as a patient with a median of creatinine clearance ≥130 mL/min/1.73 m2 over the period of admission. Four variables were tested, Simplified Acute Physiology Score II (SAPS II), male gender, age, and trauma as cause for ICU admission. An analysis (patient based and clearance based) was performed with logistic regression. RESULTS: Of 475 patients, 446 were included in this study, contributing to 454 ICU admissions and 5586 8-hour creatinine clearance (8h-CLCR). Overall, the prevalence of patients with ARC was 24.9% (n = 113). In a subset of patients with normal serum creatinine levels, the prevalence was 43.0% (n = 104). Of the set of all 8h-CLCR measurements, 25.4% (1418) showed ARC. In the patient-based analysis, the adjusted odds ratio was: 2.0 (confidence interval [CI]:1.1-3.7; P < .05), 0.93 (CI: 0.91-0.94; P < .01), 2.7 (CI: 1.4-5.3; P < .01), and 0.98 (CI: 0.96 -1.01; P = .15), respectively, for trauma, age, male sex, and SAPS II. In the clearance-based analysis, the adjusted odds ratio were 1.7 (CI: 1.4-1.9; P < .01), 0.94 (CI: 0.932-0.942; P < .01), and 2.9 (CI: 2.4-3.4; P < .01), respectively, for trauma, age, and male sex. CONCLUSIONS: Trauma, young age, and male sex were independent risk factors for ARC. This condition occurs in a considerable proportion of critical care patients, which was particularly prevalent in patients without evidence of renal dysfunction.

Hospital-Acquired Pneumonia in a Multipurpose Intensive Care Unit: One-Year Prospective Study.

INTRODUCTION: Hospital-acquired pneumonia continues to be a frequent complication in the intensive care unit and an important cause of admission in the intensive care unit. The aim of our study was to evaluate the demography, incidence, risk factors, causative bacterial pathogens and outcome of all episodes of Hospital-acquired pneumonia in our unit. MATERIAL AND METHODS: Prospective observational study, at a tertiary university hospital during one year (2014) including all the cases of hospital-acquired pneumonia in the intensive care unit. RESULTS: Sixty patients were identified with pneumonia. Thirty-five (58.3%) had an intensive care unit acquired pneumonia, corresponding to 6.9 cases/1000 intubation-days. Antibiotic treatment in the previous 30 days was present in 75% of the cases. The incidence of Staphylococcus aureus, Pseudomonas aeruginosa and Acinetobacter baumannii was 26.2%, 20.0% and 9.2%, respectively. Patients with late-onset hospital-acquired pneumonia (≥ 7 days) showed higher frequency of non-fermenting Gram-negative bacilli isolates, and methicillin-resistant S. aureus. Combination therapy was performed in 67.0%, and de-escalation in 18.3%. The mortality rate was 18.3%. The adjusted odds ratio for intensive care unit mortality in the group of patients with non-intensive care unit acquired pneumonia was 5.2 (95% CI of 1.02 - 22.10; p = 0.046). DISCUSSION: The knowledge of local bacterial flora and resistance patterns is of crucial importance and strongly recommended. This evidence increases the probability of success of empiric antibiotic therapy. CONCLUSION: S. aureus was the predominant causative agent of nosocomial pneumonia. The most frequent risk factor identified for infection with multidrug-resistant organisms was previous treatment with antibiotics. Multidrug-resistant organisms were present in 45% of documented hospital-acquired pneumonias. In admitted patients with non-intensive care unit acquired pneumonia, the intensive care unit mortality rate was nearly five times higher compared to intensive care unit acquired pneumonia.

Introdução: A pneumonia adquirida no hospital é uma complicação frequente nos doentes críticos e uma importante causa de admissão nos Cuidados Intensivos. O objetivo deste estudo foi avaliar a demografia, incidência, fatores de risco, microbiologia e outcome da pneumonia nosocomial num Serviço de Medicina Intensiva. Material e Métodos: Estudo prospectivo e observacional, num hospital universitário terciário, durante o período de um ano (2014). Resultados: Foram avaliados 60 doentes. Trinta e cinco (58,3%) com pneumonia nosocomial adquirida no Serviço de Medicina Intensiva, correspondendo a 6,9 casos/1000 dias de intubação. A antibioterapia nos últimos 30 dias esteve presente em 75% dos casos. A incidência de Staphylococcus aureus, Pseudomonas aeruginosa e Acinetobacter baumannii foi de 26,2%, 20,0% e 9,2% respetivamente. Os doentes com pneumonia de início tardio (≥ 7 dias) apresentaram maior frequência de bacilos Gram-negativos não-fermentadores e S. aureus resistente à meticilina. A antibioterapia em associação foi aplicada em 67,0% e a descalação em 18,3% dos doentes. A taxa de mortalidade foi 18,3%. O odds ratio ajustado de mortalidade no grupo de doentes críticos com pneumonia nosocomial adquirida fora da UCI foi de 5,2 (95% CI de 1,02 ­ 22,10; p = 0,046). Discussão: O conhecimento da flora local bacteriana e os padrões de resistência bacteriana são de grande importância e amplamente recomendados. Esta evidência aumenta a probabilidade de sucesso da antibioterapia empírica. Conclusão: O S. aureus foi o agente causador predominante da pneumonia. O fator de risco mais frequente para infecção por organismos multirresistentes foi o tratamento prévio com antibióticos. Organismos multirresistentes estavam presentes em 45% das pneumonias adquiridas no hospital de origem bacteriana comprovada. O grupo de doentes críticos com pneumonia nosocomial não adquirida no Serviço de Medicina Intensiva apresentou um risco de mortalidade cerca de cinco vezes maior comparativamente aos doentes com pneumonia nosocomial adquirida no Serviço de Medicina Intensiva.