The relationship between thought process disturbance and the structure of internal object relations was investigated by comparing Rorschach Special Scorings and content variables that reflected developmental levels of object relations. Selected Special Scorings from the Comprehensive System (Exner, 1990) and composite (WSum6) scores were correlated with Urist's (1977) Mutuality of Autonomy Scale (MOA) on the Rorschach protocols of 35 borderlines, 15 schizophrenics, and 19 narcissists. Correlations between composite scores of severe thought process disturbance and severe imbalance in internalized object representations were highly significant, p < .0001. The hypothesis that there is a significant relationship between disturbance in internalized self/object differentiation and thought process disturbance was supported. Implications of this study are discussed as they relate to empirical validation of theoretical constructs concerning ego function deficit and self/object disturbance.
Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose To describe a virtual clinical pharmacy service as a model of care to support rural and remote Australian hospitals that otherwise would not have access to onsite pharmacists. Summary Many small hospitals in Australia do not have an onsite hospital pharmacist and struggle to support and optimize patient care. To increase access to a hospital pharmacist’s specialized skills and medication knowledge, a virtual clinical pharmacy service was designed and implemented in 8 hospitals across rural New South Wales, Australia in 2020. The virtual clinical pharmacy service focuses on the core role of hospital pharmacists, including obtaining a best possible medication history, medication reconciliation at transitions of care, medication review, interprofessional team meetings, provision of patient-friendly medication lists, antimicrobial stewardship, and patient and clinician education. The model is aligned with recognized standards of practice for the delivery of clinical pharmacy services in Australian hospitals. This article details a model of care for translation across other settings. It provides the necessary details on clinical services, processes, supporting structures, an evaluation framework, and other important considerations for implementing virtual pharmacy services. Conclusion This research provides policymakers, health service planners, and practitioners with a model for providing comprehensive clinical pharmacy services virtually to increase the safe and effective use of medicines. Future publication of the findings of a formal evaluation of the model’s acceptability and effectiveness is planned.
Background: Virtual healthcare services are usually provided from urban centres to outpatient clinics or underserved rural areas. This study utilises virtual pharmacy as an innovative model to provide services to a metropolitan hospital from a rural area. Aim: This study assesses the feasibility, and patient and staff acceptability of a Virtual Clinical Pharmacy Service (VCPS) in a tertiary metropolitan hospital ward with limited on-site clinical pharmacy services. Method: Pharmacists from a rural health district provided telepharmacy services for nine weeks. Data on service provision and detection of medication-related issues were captured in the electronic health record. Service acceptability was assessed through a staff focus group and patient acceptability by a patient-reported experience measures (PREM) survey. Ethical approval was granted by the Greater Western Human Research Ethics Committee (Reference no: 2021/ETH00097). Results: The VCPS demonstrated high utilisation, with 535 clinical and medication reviews provided for 225 patients. Virtual medication reviews identified 151 medication-related issues or recommendations. PREM surveys (n = 22) were supportive of the VCPS model. Staff valued the service and reported ease of access to specialist medication advice and confidence that patient medications were correct. Staff raised patient confidentiality in open wards and lack of experience using virtual healthcare as barriers to the implementation. Conclusion: Feasibility was demonstrated by high service utilisation, detection of medication-related issues, and measures of acceptability from patients and staff. The VCPS offers a solution to enhance sustainability and service agility by delivery of clinical services when face-to-face is not practicable or available. Further research is required to demonstrate efficacy and to confirm patient acceptability.
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