Academic literature on the topic 'Psychoanalytically oriented clinical approach'

The authors discuss the experience of treating eating disorders at a psychoanalytically oriented therapeutic community in Italy. Teamwork and group activities are the bases of the treatment, at least to the point that the experience of the collectivity does not hinder the individual subjective expression of each patient. The treatment includes several different steps in the process of the admittance and release of patients and the subjectivation involved in the process is considered very important. A clinical vignette is presented at the end of the article.

This article relies on psychoanalytic theory and technique to examine the dynamics of a couple with a sexual aversion disorder in one partner and to provide treatment. It uses the language of object relations, including Ogden’s (1989a,b) reformulation of Freud’s notions about the oedipal complex. In doing so, it defies the popular trend in sex therapy to employ behavioural methods, as well as the less commonly used approach to integrate psychoanalytic with behavioural techniques. The outcome supports the prospect of psychoanalytically oriented therapists reclaiming sexual difficulties as entities that are within the domain of their clinical expertise. Additionally, it adds to the literature on sexual desire disorders and because the partner, in this case, who presents with the sexual problem is male, it counters commonly held myths about male sexuality and recognises the complexity of their sexual functioning.

Abstract. Assessing change during long-term psychotherapy can be a challenging and uncertain task. Psychological assessments can be a valuable tool and can offer a perspective from outside the therapy dyad, independent of the powerful and distorting influences of transference and countertransference. Subtle structural changes that may not yet have manifested behaviorally can also be assessed. However, it can be difficult to find a balance between a rigorous, systematic approach to data, while also allowing for the richness of the patient’s internal world to emerge. In this article, the authors discuss a primarily qualitative approach to the data and demonstrate the ways in which this kind of approach can deepen the understanding of the more subtle or complex changes a particular patient is undergoing while in treatment, as well as provide more detail about the nature of an individual’s internal world. The authors also outline several developmental frameworks that focus on the ways a patient constructs their reality and can guide the interpretation of qualitative data. The authors then analyze testing data from a patient in long-term psychoanalytically oriented psychotherapy in order to demonstrate an approach to data analysis and to show an example of how change can unfold over long-term treatments.

Borderline personality disorder affects about 1–1.5% of the population. It is characterised by chronicity (from adolescence to adulthood) and a significant suicide rate (about 10%). Spontaneous improvement can be observed in some patients; however, it is estimated that specialised therapy accelerates this process several times. Psychotherapy is the recommended treatment for those with borderline personality disorder; however, it is necessary to specify the methods and principles of its application. Data from research on effectiveness (ranging from strong support to modest/controversial results requiring replication) focus on a few psychotherapy methods: dialectical behavioural therapy, schema therapy (belonging to the cognitive-behavioural approach), as well as mentalisation-based therapy and transference-oriented therapy (belonging to the psychodynamic/psychoanalytical approach). The aim of the article is to present the recommended psychotherapy methods for patients with borderline personality disorder included in the guidelines developed by institutions referring to the principles of evidence-based practice – a tripartite approach where the basis of practice is recognising methods whose effectiveness has been demonstrated in empirical studies (evidence-based treatments). We also referred to the recommendations of the American Psychiatric Association, the American Psychological Association, and the National Institute for Health and Clinical Excellence. In the summary, the principles for psychotherapy in borderline personality disorders, common to many recommendations, including the diagnosis, risk management, therapy time planning, structure, discontinuation of psychotherapy and supervision, are also discussed. According to the guidelines (American Psychiatric Association, American Psychological Association and National Institute for Health and Clinical Excellence), pharmacotherapy plays a supportive role in the treatment of borderline personality disorder, but it should be considered in the coherent treatment plan and case management – therefore the main recommendations for pharmacological treatment are also discussed.

This paper provides the historical, cultural, and clinical context for the relationship between Bruno Bettelheim (1903–1990) and Rudolf Ekstein (1912–2005). Both were Viennese-born and trained intellectuals who received doctorates in the human sciences from the University of Vienna in 1937. Both were deeply identified with lay analysis, emphasizing that for psychoanalysis to perpetuate itself it needed to promote serious and rigorous forms of research. Because Bettelheim was the better known of the two, this introduction focuses on Ekstein's family history, with special emphasis on his experience of loss and trauma and his capacity to recover from personal and educational obstacles. It argues that Ekstein was a representative product of Austro-Marxism in the period between the wars, embracing the ethical brand of democratic socialism and group solidarity that was integral to the theory and practice of Austrian Social Democracy. It discusses Ekstein's training with Moritz Schlick in philosophy and his immersion in the Vienna Circle of logical positivism. From Schlick, Ekstein evolved into a philosophical thinker who learned how to think his own thoughts. Ekstein joined the circle of psychoanalytic pedagogues who clustered around the Vienna Psychoanalytic Society, under the tutelage of Willi Hoffer,August Aichhorn and, above all, Anna Freud. The clinical component of psychoanalysis emanated from his commitment to understanding the inner world of the child. Bettelheim and Ekstein first became aware of each other from reading the analytic literature and finally met in America in the 1950s. They shared a professional interest in conducting research and doing clinical work on severely disturbed children and adolescents, including those with psychotic, borderline and autistic diagnoses. They debated the value of milieu therapy versus psychoanalytically oriented psychotherapy on such children. As their relationship evolved, the two collaborated and began a fascinating correspondence that gradually evolved into an intimate friendship. They both engaged in a polemic with Bernard Rimland, who was massively critical of their clinical work and a hostile critic of psychoanalytic approaches to the treatment of disturbed children. Rimland was an advocate of a neurological approach to mental illness, with an emphasis on biology and psychopharmacology. The 22 letters that constitute the Bettelheim-Ekstein exchange began with clinical concerns, including the varieties of solitude, isolation and countertransference disruptions that may trouble the psychoanalytic researcher and clinician in dealing with primitively disordered children. It moves to other issues, including mutual support during the Rimland Affair. As the two became more friendly, a pattern of good-natured competition and envy appeared. The two engaged in a heated exchange on the question of whether contemporary Vienna remained as anti-Semitic as it had been in their respective youths: Bettelheim, the concentration camp survivor, argued that nothing had changed and that most Austrians remained viscerally anti-Semitic; Ekstein, the Austro-Marxist, contended that one could not blame a generation born after World War II, holding that in his experience many Austrians had examined their consciences and held distinctly different opinions from their parents or grandparents. Toward the end of their correspondence, we encounter Ekstein's tender sensitivity to Bettelheim's descent into depression as a result of the death of his wife, Trude, leading eventually to recurrent episodes of suicidal ideation and plans for his own suicide. The letters testify to a unique friendship with a somewhat old-world quality.

Cette thèse, qui s’inscrit dans le champ clinique d’orientation psychanalytique en sciences de l’éducation et de la formation, propose d’analyser selon quelles modalités le soi-élève influence l’enseignant à son insu dans sa pratique professionnelle. La thèse comporte 5 parties. La première partie est consacrée à la construction de l’objet de recherche. Le chercheur y explore notamment les concepts de soi-élève et de soi-enseignant. La seconde partie, est consacrée au cadre théorique dans lequel cette recherche s’inscrit. Le chercheur y expose notamment sa rencontre avec les savoirs de la psychanalyse puis explore la question de la scientificité de la démarche en ce qu’elle a de singulier et de spécifique. Le cadre théorique ainsi posé permet de préciser le rapport entre le chercheur et son objet-sujet de recherche, et d’exposer comment la construction singulière de son rapport au savoir s’exprime à son insu dans sa pratique professionnelle. La troisième partie, présente la méthodologie mobilisée pour le recueil et l’analyse des données, à savoir les groupes d’analyse des pratiques professionnelles, les notes d’après-coup, et le travail dans le cadre d’un groupe supervision qui permet entre autre l’élaboration du contre-transfert. A l’aide de situations issues de groupes d’analyse de pratiques que le chercheur a menés, il rend compte du travail d’élaboration que sous-tend la démarche clinique d’orientation psychanalytique afin de percevoir comment le soi-élève s’exprime inconsciemment dans les pratiques des enseignant.e.s ou des formateurs. La quatrième partie, est consacrée à un entretien clinique de recherche effectué auprès d’une enseignante d’histoire géographie du secondaire. A l’aide du matériel analysé, le chercheur examine selon quelles modalités son soi-élève l’oriente dans sa pratique professionnelle et dans ses choix pédagogiques. La cinquième et dernière partie, propose d’approfondir les concepts qui ont émergé lors de la recherche afin d’étayer plus en profondeur les analyses, ainsi que de proposer quelques perspectives pour la formation des enseignants et la recherche
This thesis, which fits in the psychoanalytically-oriented clinical field of Éducationand training sciences, proposes to analyze the ways in which the pupil-self unwittingly influences the teacher in his or her professional practice. The thesis is divided into five parts.The first part is devoted to the construction of the research object. In particular, the researcher explores the concepts of pupil-self and teacher-self. The second part is devoted to the theoretical framework within which this research is embedded. In particular, the researcher describes his encounter with psychoanalytic knowledge, and then explores the question of the « scientificity » of the approach in all its singular and specific aspects. The theoretical framework thus established makes it possible to clarify the relationship between the researcher and his object-subject of research, and to show how the singular construction of his relationship to knowledge expresses itself unbeknownst to him in his professional practice.The third part presents the methodology used for data collection and analysis, i.e. the practice analysis groups, the subsequent notes, and the work in a supervision group, which, among other things, enables the elaboration of counter-transference.Using situations from groups of professionnel practices analysis groups that the researcher has led, he reports on the work of elaboration that underlies the psychoanalytically-oriented clinical approach, in order to perceive how the pupil-self unconsciously expresses itself in the teachers or trainers practices.The fourth part is devoted to a clinical research interview with a secondary school history-geography teacher. Using the analyzed material, the researcher examines the ways in which her pupil-self guides her professional practice and pedagogical choices. In the fifth and final part, the concepts that emerged during the research are explored in greater depth to thoroughly underpin the analyses, as well as to propose some perspectives for teacher training and research

This dissertation examined the development of writing in school-age children from a process-oriented perspective by examining pause patterns and the characteristics of language bursts between pauses. Study 1 investigated the development and operation of different writing processes during on-line text production of typically developing third and fifth graders. Fifth graders paused less frequently than third graders, but their pause duration was similar to the pause duration of third graders’. Fifth graders wrote more words between pauses than third graders. Revision rates were similar in both grades. The findings suggest that fifth graders are more advanced than third graders in the development of writing processes (i.e., planning, text generation, and transcription) whereas revising process does not mature from third grade to fifth grade. The advanced development of planning, text generation, and transcription in fifth grade facilitates the operation of these processes to partially overlap with each other. Revising process does not occur as frequently as other processes in both grades. However, when it does, its operation can sometimes overlap with the operation of text generation and transcription.

Study 2 investigated the effects of writing mediums (i.e., handwriting and typing) on the operation of writing processes during on-line text production of typically developing fifth and seventh graders and on the relation between writing processes and writing quality. Pauses occurred more frequently in typing than in handwriting. As typing skills improved from fifth grade to seventh grade, difference in pause rate between typing and handwriting decreased. Words between pauses were shorter in typing than in handwriting. Overall revision rate and meaning revising rate were higher in typing than in handwriting. There were some indications of positive association between meaning revision rate and writing quality. Overall pause rate was negatively associated with writing quality in fifth grade in both mediums. The findings suggest that the way handwriting and typing influenced the operation of different writing processes differed. However, the role of writing mediums in accounting for the relation between writing processes and writing quality appears to be limited.

This research provides evidence that standards based Clinical Decision Support (CDS) at the point of care is an essential ingredient of electronic healthcare service delivery. A Service Oriented Architecture (SOA) based solution is explored, that serves as a task management system to coordinate complex distributed and disparate IT systems, processes and resources (human and computer) to provide standards based CDS. This research offers a solution to the challenges in implementing computerised CDS such as integration with heterogeneous legacy systems. Reuse of components and services to reduce costs and save time. The benefits of a sharable CDS service that can be reused by different healthcare practitioners to provide collaborative patient care is demonstrated. This solution provides orchestration among different services by extracting data from sources like patient databases, clinical knowledge bases and evidence-based clinical guidelines (CGs) in order to facilitate multiple CDS requests coming from different healthcare settings. This architecture aims to aid users at different levels of Healthcare Delivery Organizations (HCOs) to maintain a CDS repository, along with monitoring and managing services, thus enabling transparency. The research employs the Design Science research methodology (DSRM) combined with The Open Group Architecture Framework (TOGAF), an open source group initiative for Enterprise Architecture Framework (EAF). DSRM's iterative capability addresses the rapidly evolving nature of workflows in healthcare. This SOA based solution uses standards-based open source technologies and platforms, the latest healthcare standards by HL7 and OMG, Decision Support Service (DSS) and Retrieve, Update Locate Service (RLUS) standard. Combining business process management (BPM) technologies, business rules with SOA ensures the HCO's capability to manage its processes. This architectural solution is evaluated by successfully implementing evidence based CGs at the point of care in areas such as; a) Diagnostics (Chronic Obstructive Disease), b) Urgent Referral (Lung Cancer), c) Genome testing and integration with CDS in screening (Lynch's syndrome). In addition to medical care, the CDS solution can benefit organizational processes for collaborative care delivery by connecting patients, physicians and other associated members. This framework facilitates integration of different types of CDS ideal for the different healthcare processes, enabling sharable CDS capabilities within and across organizations.

碩士
長庚大學
護理學研究所
93
The concept of clinical pathway is to take the process of hospitalization from admission to discharge as an operational procedure when a patient needs to go to the hospital for a treatment. Through monitoring of the process and the probable variance between the pathway and the actual phenomenon, the quality of care will be continuously improved and the resources be more efficiently utilized. The Bureau of National Health Insurance Program is going to implement the Case Payment System (CPS), which requires the use of clinical pathway. As a result, many hospitals will take care of hundreds of patients using the clinical pathway at the same time. However, the limited manpower that is accessible makes it difficult to monitor the outcomes of using theses clinical pathway manually. To manage the implementation and exert a better control over cost and quality, we commend a solution that involves the use of a computerized clinical pathway system. Hence, this research was designed with the following objectives: (1)To analyze the usage of clinical pathways that is currently in place and managed manually;(2)To analyze the nurses’ requirements specifically for computerization of the clinical pathways; and to construct the management model for cases using clinical pathway Cases based on ARIS. The study took place in a regional teaching hospital located in north Taiwan. Ten nursing subjects were first recruited to answer an open-ended questionnaire to understand their opinions about the weakness or problems related to clinical pathway manually. Sixty-three nursing subjects were then recruited from three surgical wards to participate in answering the pre-determined questionnaire and attending the semi-structured interview. The findings show that 80% of nurses considered there were too many documents which they had to repeatedly fill in. The same information could also be required on different papers and it took too long to do the paper work. When the need for a computerized clinical pathway system was examined, the average score is 4.3 suggesting a very strong desire. Among all items related to benefits of a computerized system, the subjects perceived the need to reduce the error resulted from repeated writing was the top priority, while to obtain information about the patient’s condition, treatment and care came second. For the design of a user interface, the average score was 4.32 and displaying updated information about the patient was considered to be most important, followed by rapid response of the system. One interesting finding was that there was a significant difference in requirements for interface design between nurses who had a university baccalaureate qualification and those without. It suggests that the former expected more than the latter who were basically college graduates. Based on the findings of this study, a computerized clinical pathway system was designed focusing the good principles of organization, functionality, information and control. ARIS was used to construct the system and formulate the implementation plan, which will be integrated with the current HIS in action. It is envisioned that such an integrated system will help us realize our objectives to build a truly integrated medical and nursing information system and to improve the quality of patient care.

Research Context: With the recent maturity of various cutting-edge technologies, many industries have been motivated to adopt digital transformation in their business. In fact, an increasing number of companies that cling to traditional physical business channels, services, and methodologies start to face the real threat of being left behind. Not only these companies struggle to extend their market share, but also they can not retain their current clients and customers. On the other hand, the followers of the digitalization wave manage to survive and grow their business by integrating the opportunities of technology to drive success and innovation. In the retail industry, the famous example of the retail-lead Amazon, which started digital retail innovation two decades ago, can now be easily recognized. Nowadays, there are many successful digital innovations include Airbnb in lodging and housing, Uber and MyTaxi in transportation, Car2go in car sharing, and many more other examples in almost all fields. To this end, we can define service digitalization as the process of reshaping traditional analog/physical form of services with a new digital design that brings added value to both industries and their clients. One of the main reasons why some industries can not cope with the recent service digitalization trend is that they do not put enough effort and management attention into this digital transformation. For example, some companies succeed partially to define concrete regular plans for digitally revolutionizing their products but they rarely do that to the related services. Imagine the modern hospitals, where available medical devices, clinical tools, and healthcare-related products available to physicians have been updated regularly, while the service experience through the various practices and health processes is still the same as it was many years ago. Undoubtedly, the desired comprehensive digital change would be difficult to be applied with a large base of legacy assets optimized for a certain way of working. Despite that, many businesses focus their intention and employ their assets to harness digital technology, redefine service offerings, and improve the customer experience. As a result, they proceed to both lower their costs and gain a competitive advantage in their market. To support overcoming any issues and challenges that hamper a successful and comprehensive digital transformation in industries, we need to carefully consider all the factors that add to its success. Particularly, we aim to understand the evolving service digitalization landscape so that companies can learn to tap the potential for service innovation and seize the digitalization opportunities. To do so, we have discussed the main elements that draw jointly the promising service digitalization innovation as shown in Figure 1. These elements are divided into two main parts: the proposed principles of service innovation to be followed, and the recent evolving technological advents and trends that can be employed to drive the digitalization revolution. As for the first part, the proposed principles are: (i) systematic service innovation process, (ii) simple service delivery paradigm, and (iii) user-driven service design. The second part refers to the recent striking technological trends that are profoundly reshaping the future of service digitalization while being also promoted by the emergence of the fourth industrial revolution (or as referred to by the term "Industry 4.0"). These trends include but are not limited to the Internet of Things (IoT), Mobile and Pervasive Computing, Mobile Internet, Fifth-Generation Wireless Technologies (5G), Artificial Intelligence (AI) and Machine Learning (ML), 3D Printing, Robotics, etc. To sum up, exploiting these technological trends while following the indicated principles will eventually lead to the targeted service innovation, and altogether draw the promising service digitalization landscape. The main proposed principles are marked in blue, while the recent evolving technological trends are marked in red. One of the current game-changing technological trends that has a huge impact on the future of service digitalization is IoT, which refers to all the physical hardware devices (referred to as "things") that are employed into a specific space and connected over a network (e.g., Internet) so that they can communicate and interact (and possibly be monitored and controlled remotely). These connected devices, which are distributed through this space, collect data about their surroundings and perform corresponding actions (i.e., sensors and actuators). They can also share their collected and generated data among them in order to perform more complex actions within the whole space, through which this space can derive its smartness and can be interacted with as a unified coherent unit. In other words, connected hardware devices act actively and coherently influencing the whole environment at once, and the results of the actions influence the future computations of the devices themselves. The extension of this approach to every kind of environment is the conceptual base of Pervasive and Ubiquitous Computing Systems. In order to understand the implied significance of IoT, we can imagine a world in which the environment interacts with its inhabitants. The indication here is not just providing a passive interaction, rather it involves the environment itself as an active participant. An environment that learns the inhabitants’ preferences and can help each of them in a personalized way. This environment can be considered a smart or intelligent space that has always had its charm on people’s imagination, as a symbol of technological progress and lifestyle of the future. This concept of smart space can be applied to a huge variety of environments including airports and train stations in transportation, hospitals and clinics in healthcare, schools and universities in education, museums and archaeological sites in tourism, stores and shopping malls in retail, etc. Unfortunately, the world is still far from the full implementation of this kind of scenario, but the scientific community started to put particular attention to the research fields strictly correlated to this topic. After all, IoT is a key ingredient towards a successful and comprehensive realization of smart spaces. As we are approaching the new era of smart spaces, the digitalization of the provided services in such spaces should evolve accordingly. In fact, smart spaces try to help their inhabitants by minimizing the needed physical and cognitive effort while accomplishing tasks, and therefore, providing a more natural interaction within the space. To that extent, the main goal should be developing digital services that exploit the new opportunities of smart spaces in order to support a natural user-oriented interaction in a way that minimizes the end user’s need to interact with computers as computers. In retail, for example, the self-checkout service can be redesigned innovatively in the context of a smart store. In such a store, the shopping cart can be dynamically assigned to its current user possibly by Radio-Frequency IDentification (RFID) card that securely identifies users and their preferred payment method. During the shopping process, the cart automatically identifies shopped items possibly by reading their barcodes. At the end of the shopping journey, the user can smoothly and quickly checkout from the store with only one click at the checkout Point Of Sale (POS) confirming all the shopping items and the final price. Such seamless interaction is the ultimate goal of exploiting smart space’s digital opportunities in the generation of new innovative digital services design in order to achieve satisfying User eXperience (UX). Failing to adhere to the full potential of smart spaces during the engineering process of the digital services will probably lead to a naive service design, which in turn can result in a bad UX. At this point, the provided UX is considered a key indicator of the quality of the interactive technological solution and a dominating factor for the success of any digital service. In general, UX can be referred to as the user’s perception of Human-Computer Interaction (HCI) through a specific channel or device. In other words, it describes the user’s experience of using a software system deployed into a device or across a set of devices (i.e., interaction channels or touchpoints). By analyzing this concept in the field of digital services, it can be inferred that this experience will be based not only on the ‘look and feel’ of the developed User Interface (UI) but also on its practical aspects such as usability and efficiency. This means implementing more in-depth UX values while designing the digital service instead of focusing on how to employ advanced technologies and solve UI technical challenges, which in turn considers providing more user-driven functionalities rather than usable UI alone. In the context of smart spaces, providing innovative digital services requires a well-designed UX, which aims at investigating a comprehensive service design to derive a more natural interaction with both the physical and digital world of the space. First of all, this targeted design involves facilitating both direct and indirect users’ interaction with all the connected devices/objects employed into this space, while considering their proximity to the user (physically and psychologically) at the time of interaction. Moreover, the required design should support a consistent experience across all touchpoints in the space, which does not necessarily mean to implement identical interfaces for all interaction channels through the space but rather to ensure that users motivations and goals will be supported accordingly at each interaction channel, and therefore delivering the desired coherent experience in total. Furthermore, the design should follow a user-driven methodology that pays close attention to how the actual user will be using the service in the related defined context. Considering these aspects of a satisfying UX design for digital services in smart spaces will eventually support users in a successful and joyful accomplishment of required goals/tasks in such spaces while driving the related business success. Following this direction, many research work in HCI has been targeting how to customize applied technologies to meet humans’ natural interaction in various applications and contexts. In particular, User-Centered Design (UCD) approaches, which promote UX by putting the actual user at the center of the system’s design, implementation, and evaluation processes, have been studied. These approaches employ users’ cognitive abilities (such as perception, memory, learning, problem- solving, etc.) to steer a successful realization of Information and Communications Technology (ICT) applications and software solutions by anticipating and eliminating all the factors that can lead to a bad UX, and therefore, a possible failure. However, despite all the recent efforts, there is still no common accepted methodology to precisely define, measure, and evaluate UX and its factors in the research literature. This is particularly true in the context of smart spaces, where each connected object, device, or interaction channel that is used by some user in this space create possibly a completely new UX, which can be seen as a momentary, primarily, and evaluative feeling for that interacting user. Given these observations, a promising UX of digital services in smart spaces should shift the attention from all the expected touchpoints (related to each digital service) in the space to the humans and their feelings while interacting with them (the "user" side of the intended digital service). To conclude, in order to capture a positive UX that leads to an innovative digital service delivery in smart spaces, we need to adopt a customized UCD approach tailored to that context and the related defined scenario, which ensures a user-driven methodology throughout the whole system’s realization (i.e., design, implementation, and evaluation) process and iterative prototyping. Research Objectives and Contributions: In this thesis, we aim to investigate and exploit the role of applying UCD methodologies when realizing (i.e., designing, implementing, and evaluating) service digitalization in smart spaces in order to leverage positive UX, so that we can derive the required service innovation and success. In particular, we have chosen three case studies to analyze and validate the effectiveness of this approach. We have formulated our research objectives and the related contributions around the selected case studies as follows: • Localization as a Service: the first case study discusses the digitalization of localization services in smart spaces. More precisely, it targets the retail industry in which a smart retail space helps users (both customers and employees) to localize themselves, the available retail items, and possibly different store’s parts. As a result, an indoor navigation system can be built employing these localization services to guide users effectively while performing related tasks in this smart retail environment. While this proposed system can help customers through their shopping routine, the main purpose is dedicated to retail employees supporting them in the pick-&-pack order fulfillment scenario, and allowing them to easily manage items (e.g., inserting new items, updating current ones, etc.). Based on these details, the first objective of this thesis is to: O1. Define a methodology for a complete development of innovative digital localization services in a smart retail space (e.g., store or warehouse), which should support extant physical localization techniques in the space (e.g., a physical floor plan map, printed shelves numbers, etc.) while delivering a reliable and user-friendly digital indoor navigation system through the space, with a cost-effective added value. The proposed methodology must consider UX foundations while building the digital map of the retail space (knowing the store layout and where the items are located in the store dynamically), localizing persons within this map (calling for the selection of suitable technologies and technology combinations), and providing navigation and routing solution for retail employees mainly (which can be possibly extended later for customers too). Regarding the first objective O1, the following research contributions have been achieved: C1-1 Investigating UCD techniques to realize the proposed system while considering a real use case in the retail industry. C1-2 Performing a complete analysis of the requirements (both functional and non- functional) of the related retail partner. C1-3 Building task flow diagrams based on the expected positive UX flows through all possible encountered channels in the space while following the analyzed requirements. C1-4 Implementing a running prototype of the system that deploys the required digital localization service. C1-5 Validating the acquired UX through a robust evaluation user study considering main quantitative and qualitative measures related to the defined retail scenario. This research part was conducted in the context of an EU-research project called "FIRST": virtual Factories: Interoperation suppoRting buSiness innovaTion (EU-project number: 734599) within the programs RISE (Research and Innovation Staff Exchange) and MSCA (Marie Sklodowska-Curie Actions) and "Horizon 2020" [9]. The FIRST project includes different work packages in different areas related to automation and business innovation in the industry. In detail, the work was conducted in collaboration with a german retail-lead industry partner of this EU project called GK Software SE (EU-registration number: 918734628). While working on this project, a one-year secondment to this company office in Germany was arranged for better collaboration on the aforementioned topics. Besides this concrete research topic, the secondment included attending many seminars and presentations for different speakers from both academy and industry in various innovation topics regarding the retail industry. • Clinical Guidelines as a Service: Healthcare is considered one of the most important fields for human development, and a revolutionary industry with a significant business segment. Recent efforts try to ensure more efficient and personalized delivery of care procedures by enabling flexible access to medical and patient-related information empowered by advanced distributed clinical mobile technologies among healthcare practitioners. To that extent, this case study targets the healthcare industry and is directed towards providing the required clinical guidelines as a digital service to doctors while delivering the needed care to patients. In a smart healthcare space, this digital service can be deployed on mobile devices, and their execution and mobile orchestration among clinical staff can be further supported by the connected medical objects and devices employed in the space. In order to achieve the required structured implementation of the proposed service framework, the second objective of this thesis is: O2. Define a generic development methodology for realizing innovative digital services facilitating clinical guidelines enactment and fulfillment in a smart healthcare space (e.g., hospital or clinic). This methodology should provide a system that employs advanced technologies in such a space, with the main focus on utilizing clinical mobile technologies, to support doctors in a personalized and patient-centered delivery of healthcare operations. Besides, this methodology should promote positive UX practices of working doctors ensuring a patient-centered clinical operation in such a challenging environment by eliminating overwhelming cognitive and physical demands while allowing a non-invasive interaction with the system, which in total alleviates expected medical errors. Regarding the second objective O2, the following research contributions have been achieved: C2-1 Investigating UCD techniques to realize a digital clinical system that provides the required clinical guidelines as a digital service while addressing the chest pain clinical guideline as it is considered a common clinical case study in emergency healthcare. C2-2 Analyzing the general nature of healthcare processes and their related clinical tasks in chronological order, from patient registration until patient discharge, in order to correctly identify and collect the related clinical characteristics of the selected clinical guideline and derive corresponding patient-specific care pathways that can be digitally implemented. C2-3 Introducing a reasonable digital representation of the generated care pathways by utilizing the Process-Aware-Information-System (PAIS) model and exploiting concepts from Business Process Management (BPM) in order to ensure process-driven automa- tion and execution of clinical tasks following a proper enactment of the whole clinical guideline. C2-4 Harnessing the required positive UX by adopting a multimodal graphical user interface (GUI) with both vocal and touch interaction features coupled well with the process- driven execution of the clinical tasks. This multimodal interaction supports doctors to flexibly execute clinical guidelines, switching dynamically between the touch and hands-free (i.e., vocal) modes as required for the proper fulfillment of care procedures. C2-5 Implementing a running prototype of the system that deploys the required digital service, and validating the acquired UX through a robust user evaluation performed in a real hospital with the actual users (i.e., doctors) by analyzing the usability and effectiveness of the system. This research part was partially supported by the Sapienza grants TESTMED and SUPER and performed also in the context of the Centro Interdipartimentale "Information-Based Technology Innovation Center for Health” (STITCH). • Power Saving as a Service: in this case study, we aim to provide digital services for power saving in smart spaces. Such services include controlling lighting, ventilation, air conditioning, heating, etc., based on an auto-detection strategy of the inhabitants’ presence and their current location in such a smart space. This application tends to provide a power-saving solution with an added value in huge spaces with many changing inhabitants (i.e., too many inhabitants that dynamically enters/leaves/changes location within the space). Furthermore, it can be extended to many contexts like smart home, smart store, smart hospital, smart museum, etc. Considering UX measures of such application in smart spaces will be a dominant factor for its widespread and innovation success. Based on these details, the third objective of this thesis is to: O3. Introduce a user-oriented development methodology for digitalizing automated power- saving services in smart spaces (e.g., smart home), while focusing on lighting control as the main use case that can be extended to other use cases. This methodology should skillfully employ available advanced technologies that can be integrated into such a space in order to support its inhabitants while performing ongoing activities and related tasks. Additionally, positive UX practices should be considered carefully (e.g., how fast/smooth should light be turned on/off, handling multiple users at different zones at the same time, etc.) by observing the nature of the inhabitants’ navigation pattern influenced by their usual related tasks while being in the space. Such UX considerations should alleviate overwhelming cognitive and physical demands needed to simultaneously control many different power-consuming services and devices in the space, while effectively delivering the required power-saving feature. Regarding the third objective O3, the following research contributions have been achieved: C3-1 Investigating UCD techniques to realize a digital system that provides automated power-saving services for helping users to reduce and control power consumption while navigating the space based on the current location of the navigating user (i.e., using location-based services). C3-2 Analyzing the required technologies and related technical structure for implementing such digital services, while promoting simplicity and usability. C3-3 Implementing a running prototype of the system that deploys the required digital services while considering positive UX flows that space’s inhabitants would naturally adopt. This research part was conducted in collaboration with the "Service Computing Department" at Stuttgart University. Other Contributions: Since the start of the Ph.D. program, the conducted research activities related to applied HCI and UCD are distributed in various topics around service digitalization and targeted innovation to enrich the research perspectives and skills, and therefore, to guide the core outcome of this program which is presented in this Ph.D. thesis. Besides this final main outcome, other research activities are conducted targeting the evolution and application of UCD approaches. • Evaluating Humans Collaboration Attitude towards Service Robots in Symbiotic Autonomy Settings: given the aforementioned research objectives and the related selected case studies discussing the important role of applying service-oriented computing in localization, clinical guidelines, and power-saving while adopting UCD approaches to achieve the required service digitalization innovation, this part is directed towards the context of Robotics-as-a- service (RaaS) which has a significant trend in the future of digitalization and smart spaces. These RaaS units are considered part of Autonomous decentralized systems (ADSs), whose components are designed to operate in a loosely coupled manner and data are shared through a content-oriented protocol, which can be easily integrated with other IoT and Cyber-Physical Systems (CPSs) [236, 302, 274]. In particular, this research is one of the initial efforts focusing on understanding the opportunities and challenges of integrating autonomous robots in future smart spaces, where the humans need to collaborate efficiently with them in performing tasks. To that extent, in order to operate in human-populated environments, robots need to show reasonable behaviors and human-compatible abilities. In the so-called Symbiotic Autonomy, robots and humans help each other to overcome mutual limitations and complete their tasks. When the robot takes the initiative and asks the human for help, there is a change of perspective in the interaction, which has not yet been specifically addressed by HRI studies. Based on these details, the fourth objective of this thesis is to: O4. investigate the novel scenario brought about by Symbiotic Autonomy in HRI, by addressing the factors that may influence the interaction. Regarding the fourth objective O4, the following research contributions have been achieved: C4-1 Introducing the term of “Collaboration Attitude” to evaluate how the response of users being asked by the robot for help is influenced by the context of the interaction and by what they are doing (i.e., ongoing activity). C4-2 Performing a first user study and presenting its results which confirms the influence of conventional factors (i.e., proxemics) on the Collaboration Attitude, while it suggests that the context (i.e., relaxing vs. working) may not be much relevant. C4-3 Performing a second user study to better assess the influence of the activity performed by the humans in our population, when (s)he is approached by the robot, as an additional and more compelling characterization of context (i.e., standing vs. sitting). While the experimental scenario takes into account a population with distinctive characteristics (i.e., academic staff and students), the overall findings of our studies suggest that the attitude of users towards robots in the setting of Symbiotic Autonomy is influenced by factors already known to influence robot acceptance while it is not significantly affected by the context of the interaction and by the human ongoing activity. Such findings can help to reshape innovative future RaaS design by anticipating such UX factors and addressing them skillfully in the service design. Chapter 5 discusses this research work related to UX validation via controlled user studies in the context of Symbiotic Autonomy, where humans’ collaboration attitude towards service robots was quantitatively and qualitatively measured and analyzed. This research part was conducted in collaboration with the Ro.Co.Co. Laboratory of the Department of Computer, Control and Management Engineering "Antonio Ruberti" at Sapienza University of Rome. • Evolving User-Centered Design towards Participatory Design in Service Digitalization: another research has been conducted discussing the promising evolution of UCD towards PD (Participatory Design) and the related role in delivering service digitalization innovation and success. Such evolution is directly related to the arising of new technologies ranging from smartphones to social networks which are constantly increasing interactions between people. In the ICT community, adapting technology to human nature is the key concern of UCD. However, UCD tends to neglect the emerging social dimension of technology: users are consulted in the design process, but they do not have any direct involvement or cre- ative control over the developed technological solutions. On the other hand, the collaborative and social nature of the design process is getting increasingly explicit in the Product Design community, where PD approaches are applied to involve stakeholders, designers, and end-users in the creative process of new products. Based on these details, the fifth objective of this thesis is to: O5. investigate how the integration of the unique features of PD into UCD can lead to innovation in the design process. We advocate that such innovation can be obtained by giving the right voice not only to the users who reach consensus in the design process but also to the marginals. Regarding the fifth objective O5, the following research contributions have been achieved: C5-1 Providing a deep analysis of the state of the art of Participatory Design in both ICT and Product Design communities. C5-2 Providing an exploratory model with some experiments to create innovation in the design process. C5-3 Introducing a Visual Analytics system to support the user interaction in the participative process. This research is detailed in Chapter 6 that discusses how to push forward UX of digital services by evolving UCD towards PD in which actual users participate actively in the whole design and prototyping process of the software (similarly to the product design process). This research part was conducted in collaboration with the HCI Laboratory of the Department of Computer, Control and Management Engineering "Antonio Ruberti" and the Department of Planning, Design, and Technology of Architecture at Sapienza University of Rome.

AbstractThanks to its ability to offer a time-oriented perspective on the clinical events that define the patient’s path of care, Process Mining (PM) is assuming an emerging role in clinical data analytics. PM’s ability to exploit time-series data and to build processes without any a priori knowledge suggests interesting synergies with the most common statistical analyses in healthcare, in particular survival analysis. In this work we demonstrate contributions of our process-oriented approach in analyzing a real-world retrospective dataset of patients treated for advanced melanoma at the Lausanne University Hospital. Addressing the clinical questions raised by our oncologists, we integrated PM in almost all the steps of a common statistical analysis. We show: (1) how PM can be leveraged to improve the quality of the data (data cleaning/pre-processing), (2) how PM can provide efficient data visualizations that support and/or suggest clinical hypotheses, also allowing to check the consistency between real and expected processes (descriptive statistics), and (3) how PM can assist in querying or re-expressing the data in terms of pre-defined reference workflows for testing survival differences among sub-cohorts (statistical inference). We exploit a rich set of PM tools for querying the event logs, inspecting the processes using statistical hypothesis testing, and performing conformance checking analyses to identify patterns in patient clinical paths and study the effects of different treatment sequences in our cohort.

AbstractEvery day more midwives and other healthcare practitioners (HCPs) realise that good care has to consider their clients’ sexual well-being. Still, many find it challenging to breach the topic during a consultation by talking to their clients about sexuality. This chapter explores the thresholds midwives and other healthcare practitioners experience when it comes down to talking about sex with their clients. Drawing on existing models of health and well-being, such as the biopsychosocial model of health, and existing models for communication in clinical settings, such as the ICE model, the chapter offers a simple and easy to use four-step communication model—starting with raising the issue of sexuality pro-actively and ending by making the client an offer. This approach can help healthcare practitioners to integrate sexuality into their daily practice.“Talking sexuality” is a part of the more extensive publication “Sexuality & Midwifery”, an open access textbook published by Springer Nature, geared at midwives and related healthcare professionals, providing an overview of the current scientific knowledge on sexuality and midwifery, presented in a practice-oriented way.

AbstractPatient pathway has become a key concept in the organization of healthcare. However, the materialization and operationalization of pathways often focus on work processes of health personnel, clinical decision-making, and deadlines, contradicting the strong patient-oriented perspective that is inherent in their definition. In this paper, we introduce a patient-centered perspective of kidney cancer pathways, reporting on a dual-perspective strategy to map and model patient pathways. Utilizing a multi-method approach, we map and model pathways from the perspectives of both healthcare personnel and patients and investigate the feasibility of the Customer Journey Modeling Language (CJML) for modeling patient pathways. To prevent confusion, the planned pathway as seen from the hospital perspective and the actual pathway experienced by the patient are referred to as ‘pathway’ and ‘journey’, respectively. In the paper, we describe methods to engage with healthcare professionals and patients to collect the necessary information to create precise models, and we show how precise modeling of patient pathways requires the integration of several information sources. Moreover, the study underlines the value of examining pathways from a dual perspective, as the two perspectives corroborate and supplement each other, illustrating the complexity of patient journeys. Finally, the findings provide insights into the feasibility of CJML, firstly underlining that the usefulness of visual models is context-dependent, and secondly, suggesting that the methods and subsequent visualizations may be useful as organizational, instructional, and communicative tools.

The numerousness of over-65 people in the EU-27 population will significantly increase by about 43% by 2050. The main issue is to help aging people stay healthy, active, and integrated into society. In this context, this work aims to develop a novel assistance model, for the elderly’ social and health care, based on a patient-oriented approach. The assistance model is provided through a software platform that integrates three different modules: i) frailty diagnosis and user-product/service matching, ii) users’ monitoring, data acquisition, and telemedicine, iii) organization and management of logistics. This paper focuses on the first module, showing the variables, the logics, and the necessary rules to realise the personalised product-service assignment, within the user-centred method.

Patient-centered care (PCC) approaches are critical for the delivery of high-quality care in cancer care where the therapeutic alliance between patients and the oncologists is frequent over extended periods of time. The concept of patient-centered care has received increased attention since the publication of the 2001 Institute of Medicine (IOM) report Crossing the Quality Chasm. In this study, we create and evaluate a new framework for patient-centered care in cancer using human factors approaches. Many initiatives focused on developing technologies that help foster PCC by increasing patients’ access to information and facilitating self-monitoring and patient convenience. This paper makes an important contribution to the literature by historically examining the evolution of the definitions of care approaches from disease-centered care focusing on curing the diseases to patient-centered care satisfying patients’ needs to person-centered care. Instead of treating people like victims of diseases, this model recognizes their need for more than one professional to support them emphasizing their capabilities and potential to improve their own health by themselves. It also provides a different and complementary way to the visit-oriented approach furnishing more accessible and continuous care over time, Our contribution also covers summarizing the existing measures adopted to measure its components and finally suggests a socio-technical framework based on the human factors approach to measuring PCC effectiveness. Our approach to measuring PCC is grounded in the conceptual framework we are suggesting that evaluates the effectiveness of patient-centered care based on a socio-technical perspective. We link the cognitive perception of patients towards PCC (Cognitive Sensory Input) to their exposure to external factors (Exposure) that may affect their (Cognition) behavior. A holistic approach recognizing health care as a dynamic socio-technical system in which sub-elements interact with each other remains necessary to better understand the system and its constraints in cancer care. We use a case study to emphasize the importance and need of such a human factors-based framework in providing a better quality of care and improving health outcomes. Achieving high-quality care is a complex pursuit in any setting especially for cancer care and improving the patient journey requires an integrated system of care and productive interactions among many system levels. By understanding the work system components, the design and integration of tasks, technology, and clinical processes can be reviewed to better support the respective needs of individuals while optimizing system performance. A supportive work environment and a highly engaged workforce are highly correlated with improved quality of patient-centered care and hospital performance. At the population level, case managers, navigators, quality officers, and administrators may track outcomes across patients.This framework can help organize clinical interventions that aim to control cancer patients’ behavior from a patient-centered perspective. It can also help technology designers by giving them insight into how patient-centeredness in the design of health informatics can impact cancer patients’ behavior. In addition, patient-centered designs can enhance technology acceptance among cancer patients making it easier to adopt technology for follow-up reasons by involving human factors and ergonomics principles in order to ensure successful results.

Permanent atrial fibrillation is the most important risk factor for cardioembolic stroke. Objective: to evaluate the use of anticoagulant therapy for the prevention of thromboembolic complications in patients with a permanent form of AF in outpatient settings. 422 outpatient records of patients with permanent atrial fibrillation were analyzed, of which 346 people were recommended to take anticoagulant therapy according to the CHA2DS2-VASc and HAS-BLED scales. As a result, 54.3% of patients after the initial consultation began to use the recommended treatment, after a second consultation after 11-12 months, 71.3% of patients already. Thus, in order to increase clinical efficacy, improve the quality and life expectancy of patients, a patient-oriented approach aimed at preventing thromboembolic complications is needed.

Glenohumeral dislocation is a significant clinical problem and often results in injury to the anteroinferior (anterior band of the inferior glenohumeral ligament (AB-IGHL) and axillary pouch) glenohumeral capsule. [1] However, clinical exams to diagnose capsular injuries are not reliable [2] and poor patient outcome still exists following repair procedures. [3] Validated finite element models of the glenohumeral capsule may be able to improve diagnostic and repair techniques; however, improving the accuracy of these models requires adequate constitutive models to describe capsule behavior. The collagen fibers in the anteroinferior capsule are randomly oriented [4], thus the material behavior of the glenohumeral capsule has been described using isotropic models. [5,6] A structural model consisting of an isotropic matrix embedded with randomly aligned collagen fibers proved to better predict the complex capsule behavior than an isotropic phenomenological model [7] indicating that structural models may improve the accuracy of finite element models of the glenohumeral joint. Many structural models make the affine assumption (local fiber kinematics follow global tissue deformation) however an approach to account for non-affine fiber kinematics in structural models has been recently developed [8]. Evaluating the affine assumption for the capsule would aid in developing an adequate constitutive model. Therefore, the objective of this work was to assess the affine assumption of fiber kinematics in the anteroinferior glenohumeral capsule by comparing experimentally measured preferred fiber directions to the affine-predicted fiber directions.

"The purpose of this paper is to focus the need of a reflexive stand about systemic training in family therapy in a higher education program. This training is associated to diverse social interrelationships that combines theoretical and clinical objectives, as well as research activities and community issues. We have been working in training programs at the National Autonomous University of Mexico, Iztacala Faculty, since 2001. The epistemological basis of this training are the systemic and cybernetic perspectives, and constructionist view about social construction of meanings in therapy and in educational processes. We emphasize observer implication, where the student/therapist in training is observer and observant in the therapeutic and educational process. The community context is where the therapy occurs which represents complex problems of reality. We focus at individual and community influences in problem construction and at the diverse ways the systems structure is organized. We attend the emotional, cognitive, situational, social aspects of the person of the therapist. The dialogical systemic approach lead us to consider the situation of the therapist, the supervisors and the consultants. We focus on the ethics, the relational responsibility, of the systems participants involved. We propose the search for contradictions, concordances or dilemmas, associated to family, social and gender diversity, oriented to look for alternative ways of connecting with consultants and therapists. We emphasize the positioning of persons as subjects who can act upon their realities, that can explore different ways of action upon society, at the actual historical context where we live, trying to search for individual and collective strengths and possibilities. We propose a reflexive stand when we focus our educational work, about what we do, in which theoretical and ethical perspectives we base our proposals, in order to anticipate and promote responsible professionals in connection with community needs. This reflective processes can take in account dimensions such as: plurality, complexity, diversity, systemic relationships, meaning construction, history, contexts, social resources, gender perspective, power and the implication of the person of the therapist. Power relationships between professors, clinical supervisors, students, consultants, institutional systems, could be externalized in order to approach ethical considerations in the clinical and educational processes."

Helping resident surgeons quickly and accurately develop expertise in clinical skills is crucial for improving patient safety and care. Because most surgical skills require visually aided device manipulations, developing effective eye-hand coordination is a crucial component of most surgical training. While eye-hand coordination has typically been evaluated on the basis of time to complete a task and number of errors, growing evidence suggests that task performance can be distinguished by detecting eye gaze patterns and movement planning. However, few studies have explored methods for collecting and evaluating gaze patterns without significantly impeding the user (e.g. goggle eye trackers), reducing the utility of this approach. Therefore, the current study was developed to propose and test a framework for evaluating the quality of eye-hand coordination using a novel motion analysis technique. To validate the framework, three expert and three novice resident surgeons were video-taped during ultrasound-guided central-venous catheter insertion procedures and compared. Our method was able to show that experts demonstrate distinguished patterns in adjusted accuracy, movement trajectories and time allocation. The results also showed that expert performance in eye-hand coordination appears to be characterized by goal-oriented adjustment. This research framework can be used to characterize individual differences and improve surgical residence training and can also be applied in other domains where eye-hand coordination needs to be studied without impeding user performance.

Patients need the ability to accurately and efficiently communicate their preferences across outcome domains to their healthcare providers.1-7 No existing system provides an efficient and timely approach to collect and communicate patient preferences across outcome domains to support shared decision making (SDM) in orthopaedic practice.2-4,8-19 The overarching goal of this research is to design, build, and test an app that collects baseline patient preferences and health status across orthopaedic outcomes and reports this information to the provider for use in patient care. A core component of the app is a Direct-Weighting (DW) preference assessment approach, originated from our prior research, and applied in a touchscreen based interactive design. It is envisioned that patients will use the app after scheduling a first visit to a surgeon for a new orthopaedic condition. Direct weighting (DW) approaches calculate patient-specific preference weights across outcomes by asking patients to disperse portions of a hypothetical “whole” across outcomes in a manner that reflects a patient’s preferences.20 DW has low respondent burden but it requires respondents to make “implicit” comparisons which may be difficult to conceptualize.20 However, the DW approach has become generally accepted in the quality-of-life literature and it has been shown that patients dividing up pieces of a “pie” across quality-of-life domains yields valid representations of patient preferences across the domains.20-22 However, the DW approach has not been validated with specific clinical scenarios using a clinically focused set of outcomes or by using a mobile software app. Drawing on prior research, we iteratively design and develop the app with input from prior DW research, informaticians, and clinicians. We use a qualitative approach to pilot test the app with 20 first-time visit patients presenting with joint pain and/or function deficiency. Participants were interviewed about their outcome preferences for care, used the app to prioritize outcome preferences, answered interview questions about their experience using the app, and completed a mHealth App Usability Questionnaire (MAUQ). Interview questions focused on the utility and usability of the mobile app for communicating with their provider, and capability of the app to capture their outcome preferences. Results validated five core preference domains, with most users dividing their 100-point allocation across 1-3 domains. The tool received moderate to high usability scores. Patients with older age and lower literacy found the DW approach more difficult in terms of allocating 100 points across 5 domains. Suggestions for DW interface interaction improvement included instantiation of a token/points oriented DW preference scoring methodology rather than a 1-10 sliding scale approach for improved preference weighting cognition and SDM with a provider. As more patient reported outcome (PRO) apps hit the marketplace across a broad spectrum of health conditions, these results provide evidence for a DW approach and interactive design for patients to communicate their treatment preferences to their providers.References:1.Baumhauer JF, Bozic KJ. Value-based Healthcare: Patient-reported Outcomes in Clinical Decision Making. Clin Orthop Relat Res. 2016;474(6):1375-1378.2. Slim K, Bazin JE. From informed consent to shared decision-making in surgery. J Visc Surg. 2019;156(3):181-184.3. Damman OC, Jani A, de Jong BA, et al. The use of PROMs and shared decision-making in medical encounters with patients: An opportunity to deliver value-based health care to patients. J Eval Clin Pract. 2020;26(2):524-540.4. Sorensen NL, Hammeken LH, Thomsen JL, Ehlers LH. Implementing patient-reported outcomes in clinical decision-making within knee and hip osteoarthritis: an explorative review. BMC Musculoskelet Disord. 2019;20(1):230.5. Kamal RN, Lindsay SE, Eppler SL. Patients Should Define Value in Health Care: A Conceptual Framework. J Hand Surg Am. 2018;43(11):1030-1034.6. Charles C, Gafni A, Whelan T. Decision-making in the physician-patient encounter: revisiting the shared treatment decision-making model. Social Science & Medicine. 1999;49(5):651-661.7. Niburski K, Guadagno E, Mohtashami S, Poenaru D. Shared decision making in surgery: A scoping review of the literature. Health Expect. 2020.8. Selten EM, Geenen R, van der Laan WH, et al. Hierarchical structure and importance of patients' reasons for treatment choices in knee and hip osteoarthritis: a concept mapping study. Rheumatology (Oxford). 2017;56(2):271-278.9. Kannan S, Seo J, Riggs KR, Geller G, Boss EF, Berger ZD. Surgeons' Views on Shared Decision-Making. J Patient Cent Res Rev. 2020;7(1):8-18.10. Briffa N. The employment of Patient-Reported Outcome Measures to communicate the likely benefits of surgery. Patient Relat Outcome Meas. 2018;9:263-266.

Looking for the ways to optimize clinical systemic art-psychotherapy (CSAP) of borderline mental disorders (BMD), which has shown high therapeutic efficacy according to the criteria of evidence-based medicine, showed good prospects of the concept of sanogenetic approach, focused on mobilizing the body’s own resource and self-regulatory assets. It resonates in many ways with the concept of “psychotherapy of healthy people” (PHP), clear organizational principles and a clear psychotherapeutic mission are its obvious advantage, the mission is aimed at helping a person achieve well-being through the use of his or her own resources. Particularly attractive feature of PHP for CSAP is its ideological basis: the worldview of a “militant optimist”. The most important consequence of its practical implementation is increasing of the level of positive emotional experiences of participants during a certain art therapy session (“positive emotional delta”), it is registered by them in a special art-therapy form for a comprehensive self-assessment of the psycho-emotional state (CSPES). This phenomenon is a key therapeutic factor in our art-therapy technology, its target point and important criterion for the effectiveness, it makes a principal contribution towards the fundamental solution to the problem of 172 therapeutic non-compliance (premature breaks of art-therapy), formation of a sustainable positive motivation of patients, significant reduction in time for working, constructive activation of group dynamics, therapy training and other therapeutic mechanisms. The implementation of the principles of PHP in our model CSAP is carried out with the help of a complex of special art-therapeutic techniques, positive-oriented verbal interventions, as well as organizational and technical activities, which are addressed to a healthy, safe part of the personality of patients and encouraging the multifaceted stimulation of its resource assets. Поиск путей оптимизации клинической системной арт-психотерапии (КСАТ) пограничных психических расстройств (ППР), показавшей высокую терапевтическую эффективность по критериям доказательной медицины, обозначил хорошую перспективность в этом плане концепции саногенетического подхода, ориентированного на мобилизацию собственных ресурсных и саморегулятивных активов организма. Содержательно он во многом перекликается с концепцией «психотерапией здоровых» (ПЗ), очевидным достоинством которой является наличие четких организационных принципов и ясной психотерапевтической миссии, направленной на помощь человеку в достижении состояния благополучия на основе использовании ресурсов своей личности. Особенно привлекательным положением ПЗ для КСАТ является ее идеологическая основа – мировоззрение «воинствующего оптимиста». Важнейшим следствием ее практической реализации является прирост уровня положительных эмоциональных переживаний участников в течение конкретного арттерапевтического сеанса («позитивная эмоциональная дельта»), который регистрируется ими на специальном арттерапевтическом бланке комплексной самооценки психоэмоционального состояния (КСПЭС). Данный феномен является ключевым терапевтическим фактором нашей арт-терапевтической технологии, ее целевыми ориентиром и важным критерием эффективности, вносящим основной вклад в кардинальное решение проблемы терапевтического нонкомплаенса (преждевременных обрывов психотерапии), формирование устойчивой позитивной мотивации пациентов, существенное сокращение сроков работы, конструктивную активацию групповой динамики, терапевтического обучения и других терапевтических механизмов. Практическая реализация принципов ПЗ в нашей модели КСАТ осуществляется с помощью комплекса специальных арт-терапевтических техник, позитивно-ориентированных вербальных интервенций и организационно-технических мер, адресованных к здоровой, сохранной части личности пациентов и способствующих разноплановой стимуляции ее ресурсных активов.