CONTENT: Part Two

19

SUMMER 2007

A PUBLICATION OF THE MEDICAL DIVISION OF THE AMERICAN TRANSLATORS ASSOCIATION

20

NeurologicalExamination24

Book Review

Glossarium

21Glossary ofClinical TrialTerminology

A PUBLICATION OF THE MEDICAL DIVISION OF ATA BOOK REVIEW | 19

PRACTICAL PSYCHOANALYSIS FOR

THERAPISTS AND PATIENTSby Owen Renik

In this essential new book, Owen Renik describeshow clinical psychoanalysis can focus on symptom

relief and deliver resultsefficiently. With a humane,direct, and engaging voice,he takes up how to begintreatment, how to end it, andhow to deal with the in-between. He offers chapterson the therapy of panica t t a c k s a n ddepersonalization, on how toget out of an impasse, on the

relation between sexual desire and power in theanalytic relationship, on patients who seem to wantto sabotage their treatments, on flying blind as ananalyst, and on a number of other intriguing,important practical topics. Renik's down-to-earthpresentation and discussion of clinical anecdotes,combined with useful recommendations for bothanalyst and patient, amounts to a clear and readablehow-to manual. The book is intended for all mentalhealth caregivers, patients and potential patients, andfor anyone who is curious about what makes for aneffective, helpful psychotherapy.

Praise for PRACTICAL PSYCHOANALYSIS FORTHERAPISTS AND PATIENTS:

"A brave, brilliant, and lively book that restores thecentrality of therapeutic benefit in psychoanalysis.Its structure as a casebook gives the reader thebenefit of seeing the analyst and his patients at worktogether in an array of very practical situationswhich are, at the same time, of the emotionallydeepest kind." -- Antonino Ferro, member of theInternational Psychoanalytical Association and theItalian Psychoanalytical Society.

"PRACTICAL PSYCHOANALYSIS is an exemplar ofwhat it means to be evidence-based. At every turn,Renik asks, "Is the patient being helped?" ReadingPRACTICAL PSYCHOANALYSIS is like meeting witha good consultant, liberating patients and cliniciansto look at their work with fresh eyes." -- KimberlynLeary, Ph.D., Harvard Medical School.

"From the first page we know ourselves to be in aworkshop, not a temple. His matter-of-factness isbreathtaking: what's useful is what's important,what's not need not detain us. . . . True believers areto be warned: they may never be the same again." -Allen Wheelis, author of How People Change andThe Way We Are.

"Renik is an outstanding clinician and theorist whohas redefined the two-person, therapeutic

perspective. His 'one-of-a-kind' book presentsclinical examples of thediversity of patient-analystinteractions, providingdazzling descriptions ofclinical cases, each ofwhich depicts turningpoints in the therapy. Hisb o o k i s o r i g i n a l ,t h e r a p e u t i c a l l yenlightening, and will, I

believe, broaden the perspective of its readers." --Ethel Spector Person, M.D., Training andSupervising Analyst, Columbia UniversityPsychoanalytic Center for Training and Research,Coeditor of The APPI Textbook of Psychotherapist.

PRACTICAL PSYCHOANALYSIS FORTHERAPISTS AND PATIENTSBy Owen RenikISBN 1-59051-237-5 /

by Eva Ristl

How to translate Board or Board Certified intoSpanish is not agreed upon. Comisión or Junta couldbe used for Board. The problem is that there areother medical and regulatory comisiones or juntas atthe local State level. So, it would be necessary torefer to a Junta Nacional de tal o cual especialidadand say Certificación Nacional. This is an opinion.Readers are invited to join in this conversation.

1 http://www.nbme.org/2 http://www.usmle.org/step2/Step2CS/Step2Indexes/Step2CSIndex.htm

3 http://www.abms.org/About_Board_Certification/means.aspx4 http://www.abms.org/Who_We_Help/Physicians/specialties.aspx

bariatric surgery - refers to surgery on the stomachor intestine designedto control extremeobesity. There aretwo main types: a)an adjustable gastricbanding or b) agastric bypass. Ingastric banding theband is placed in theupper portion of thestomach, close to theesophagus, so that

the size of the gastric pouch defines the amount offood that can be eaten. The size of the opening intothe pouch can becontrolled byin f l a t i n g ordeflating theband through aport that isi m p l a n t e dbeneath the skinof the abdomen.In a gastricbypass a stomachpouch is formed and detached from the rest of thestomach. Then a piece of small intestine is connectedto the pouch entirely bypassing the rest of thestomach.

Boards - in the medical field this word is most oftenassociated with either a) organizations that grantcertifications of one kind or another to physicians, orb) the tests that are required before granting suchcertification.. The National Board of MedicalExaminers (NBME)1 is the entity that administersthe tests that medical students must pass as arequisite to obtain the medical school diploma in aUS medical school. The testing assessments areknown as the United States Medical LicensingExaminations (or Steps) 2. The USMLE Step1 istaken upon completion of the first two years ofmedical school in the US or Canada. USMLE Step 2is taken upon completion of the remaining two yearsof medical school and Step 3 follows the firstpostgraduate year of training to assess thephysician’s ability to practice medicine in anunsupervised environment. Satisfactory completionof all three tests is necessary in order to obtain aState license within the United States.

The next certification category is in the hands of theAmerican Board of Medical Specialties (ABMS) 3.Following successful completion of training in aprimary medical specialty the physician must pass atest created and administered by the ABMS. Uponpassing the ABMS test for the particular specialtythe physician is then Board Certified. Furthertraining in any subspecialty area under the primarymedical specialty is conducive to obtaining furtherBoard certification by means of further successfulcompletion of the subspecialty board examination.

To illustrate the above further: examples of primaryspecialties are Internal Medicine, Surgery, Pediatricsand others. Within Internal Medicine there are 18recognized subspecialties such as Cardiology,Gastroenterology, Pulmonary Diseases, Hematologyand others. Within Pediatrics there are 21 recognizedsubspecialties such as Pediatric Cardiology,Adolescent Medicine, Child Abuse Pediatrics, etc.4

A Pediatric Cardiologist is possibly certified in bothPediatrics and Cardiology.

A PUBLICATION OF THE MEDICAL DIVISION OF ATA GLOSSARIUM | 20

A PUBLICATION OF THE MEDICAL DIVI- GLOSSARY OF CLINICAL TRIAL TERMINOLOGY | 21

Adverse drug reaction (ADR): All unintended,harmful or unpleasant responses to a medicinalproduct at any dose, used for diagnosis, prophylaxis ortreatment of diseases or modifications of physiologicalfunctions. The response is such that there is areasonable possibility that the adverse reaction wascaused by the medicinal product.

Adverse event (AE): Any medical event (includingintercurrent diseases and accidents) that occurs undertreatment with a medicinal product that does notnecessarily have a causal relationship with thetreatment.

Baseline assessment: Assessment before treatment

Blinding: The process through which studyparticipants and the study team are unaware of thetreatment assignments

Comparator (product): Any product includingplacebo used for comparison to the investigationalproduct in a clinical trial.

Contract Research Organization (CRO): A personor an organization (commercial, academic or other)contracted by the sponsor to perform one or more of asponsor’s study-related duties and functions.

Control group: Group of subjects treated withplacebo or standard therapy

by Maria Rosdolsky

Controlled study: A study in which theinvestigational product is compared with notreatment, placebo, or standard treatment.

Double-blind (double-masked) study: A study inwhich neither the subject nor the investigator orother staff members know what treatment (studydrug or comparator) the subjects are receiving

Endpoints: Outcome measures related to efficacyand safety

Exclusion criteria: Characteristics that exclude apotential subject from participating in a study

Food and Drug Administration (FDA): An agencyof the United StatesDepartment of Health andH u m a n S e r v i c e s ,responsible for regulatingfoods, drugs, and otherdietary and medicalproducts

Good Clinical Practice (GCP): A standard for thedesign, conduct, monitoring, recording, analyzingand reporting of clinical studies. GCP ensures thatthe reported data are accurate and that the subjects’rights and confidentiality are protected.

Inclusion criteria: Characteristics that a potentialsubject must meet to be eligible for participation in astudy

Intention to treat: Inclusion of all patients in theevaluation regardless of whether they received thetreatment or withdrew from the study prematurely

International Conference of Harmonization(ICH): An international body that issuesrecommendations for Good Clinical Practice (GCP)and Standard Operating Procedures (SOPs)

A PUBLICATION OF THE MEDICAL DIVI- GLOSSARY OF CLINICAL TRIAL TERMINOLOGY | 22

Screen failure: Subject who does not meet all criteriafor participating in a clinical trial.

Serious adverse event (SAE): An adverse event thatis fatal, life-threatening, permanently disabling or thatresults in hospitalization or prolongation ofhospitalization.

Single-blind (single-masked) study: A study inwhich only the subjects or the investigator know whattreatment (study drug or comparator) the subjects arereceiving.

Sponsor: An individual, company, institution ororganization taking responsibility for initiation,management, and financing of a clinical study.

Standard Operating Procedures (SOP): Detailedwritten instructions to achieveuniformity of the performanceof a specific function. SOPsmust be prepared for eachindividual or group ofindividuals with the samefunction, participating in theprocedures of the clinical trial,including the sponsor, themonitor, the InstitutionalReview Board, the investigator,and all clinic staff.

Standard treatment: Currently accepted treatmentfor a specific disease.

Study drug: see Investigational product

Study Protocol: Detailed plan of a study

Subject: Study participant

Treatment group: see Investigational group

Unblinding: Identification of the treatment code

Institutional Review Board (IRB): Ethicscommittee that is responsible for the ethical conductof clinical studies according to Good ClinicalPractice (GCP). IRBs are regulated by the Office forHuman Research Protection which is part of theDepartment of Health and Human Services (DHHS).

Investigational product (study drug): Apharmaceutical product with an active substance,being tested in a clinical trial.

Investigational group (treatment group): Groupof subjects who are treated with the investigationalproduct.

Investigator: Person responsible for conducting theclinical study at the study site.

Monitor: Person employed by the sponsor orCRO who reviews study records to determinewhether a study is being conducted in accordancewith the protocol. A monitor’s duties mayinclude, but are not limited to, helping to plan andinitiate a study, assessing the conduct of a study,and assisting in data analysis.

Placebo: Placebo is Latin and means literally “Iwill please”. A pharmaceutical preparation withno active substance that looks exactly like aninvestigational product.

Principal investigator: If there is more than oneinvestigator at a site, the principal investigator is theresponsible leader of a group of investigators.

Randomization: Random allocation of subjects tothe treatment group or the control group.

Screening: Evaluation of subjects for participationin a clinical trial according to inclusion andexclusion criteria.

A PUBLICATION OF THE MEDICAL DIVI- GLOSSARY OF CLINICAL TRIAL TERMINOLOGY | 23

RECOMMENDED WEBSITES:

www.cirp.org/library/ethics/helsinki (Declaration of Helsinki)http://en.wikipedia.org/wiki/Clinical_trial

http://www.cdisc.or/glossary/CDISCGlossaryV3.pdfwww.ClinicalTrials.gov

www.answers.com/topic/clinical-trial-1

TYPES OF CLINICAL STUDIES

Double-blind study: see page 20

Cohort study: A study in which patients whopresently have a certain condition and/or receive aparticular treatment are followed over time andcompared with another group that is not affected bythis condition.

Cross-over study: A controlled, usually double-blindstudy during which patients receive both treatment andplacebo in a consequential manner.

Early detection or screening study: A study of themethods of detecting a disease in people at risk beforesymptoms occur.

Longitudinal study: A study conducted over a longperiod of time.

Monocenter study: A study conducted at one site.

Multicenter study: A study conducted according toone protocol but at more than one site and thereforewith more than one investigator.

Open-label study: A study in which patients andphysicians are informed about the administered drugand dosages. These are phase I and some of phase IIstudies.

Parallel group study: A randomized study with atreatment and a control group who receive theassigned treatment throughout the study.

Pivotal study: A controlled, randomized, and double-blind study that is conducted with a large number ofpatients. The study presents data that the FDA uses inits decision about approval of the drug.

Placebo-controlled study: A study, in which onegroup receives a placebo.

Preventive trial: A study on measures to reduce therisk of developing a disease.

Prospective study: A study in which a group ofsubjects is recruited and monitored according tocriteria described in the protocol. Most clinical trialstoday are prospective.

Quality-of-life study: A study that investigatestreatments for improving the quality of life, usuallyconducted in very sick, sometimes terminally illpatients.

Randomized study: A study in which subjects arerandomly assigned to one or more treatment groupsand to one or more control groups.

A PUBLICATION OF THE MEDICAL DIVISION OF ATA NEUROLOGICAL EXAMINATION | 24

English → Spanish Glossary

NEUROLOGICAL EXAMINATIONENGLISH

EXAMEN NEUROLÓGICOESPAÑOL

NEUROLOGICAL STATUS ESTADO NEUROLÓGICOEQUIPMENT NEEDED EQUIPO NECESARIOReflex hammer Martillo de reflejosTuning fork DiapasónFlash light LinternaOphthalmoscope OftalmoscopioSTATE OF AWARENESS ESTADO DE ALERTAConscious, lucid Consciente, lúcidoClouding of consciousness Obnubilación mentalDrowsy, sleepy SomnolientoUnconscious InconscienteComa ComaORIENTATION ORIENTACIÓNOriented to time, place and person Orientado al tiempo, lugar y personaSPEECH HABLAAphasia Afasia

motor aphasia Afasia motorasensory (receptive) aphasia Afasia sensorial (receptiva)amnesic (nominal) aphasia Afasia amnésica (anómica)Expressive aphasia Afasia expresivaconduction (associative) aphasia Afasia conductiva (asociativa)transcortical aphasia Afasia transcorticalglobal aphasia Afasia global

Dysarthria DisartriaBulbar speech Habla bulbarScanning speech Habla entrecortadaSlurred speech Habla farfulladaSlow speech, bradyphasia Bradilalia, bradifasiaCRANIAL NERVES NERVIOS CRANEALESI Olfactory nerve I Nervio olfatorioPt. can smell coffee / vinegar El paciente puede oler café / vinagre

By Esther Diaz

A PUBLICATION OF THE MEDICAL DIVISION OF ATA NEUROLOGICAL EXAMINATION | 25

English → Spanish Glossary NEUROLOGICAL EXAMINATION

ENGLISHEXAMEN NEUROLÓGICO

ESPAÑOLII Optic nerve II Nervio ÓpticoVisual acuity, visus Agudeza visualVisual fields Campos visuales

Finger perimetry, confrontation Perimetría por confrontaciónperimetry Perimetría

Visual field defect Defecto del campo visualHemianopia / hemianopsia Hemianopsia

Fundus Fondo del ojooptic nerve papilla, optic disk Papila del nervio óptico, disco

óptico,distinct (sharp) edges of the papilla Márgenes de papila bien

delimitadosblurred disk margins (edges) Márgenes de disco mal

Delimitadospapilledema, choked disk, discedema Papiledema, edema de papilaCupping of the disc Excavación de la papilaoptic atrophy Atrofia del nervio óptico

III Oculomotor nerve, IV trochlear nerve,VI abducens nerve

III Nervio motor ocular común, IV nerviopatético, VI nervio motor ocular externo

Ocular motility Motilidad ocularConjugate eye movements Movimientos oculares coordinadosDysconjugate eye movements Movimientos oculares no coordinadosDouble vision on gaze to the left (right) Vista doble al ver a la izquierda (derecha)Pupils Pupilas

isocoria (equal size of pupils) Isocoriaanisocoria (unequal size of pupils) Anisocoriareaction to light Reacción a la luz

V Trigeminal nerve V Nervio trigéminoFacial sensibility Sensitividad facialCorneal reflex Reflejo cornealForce of masseter muscle contractions (clenchingteeth)

Fuerza de contracciones del masetero(apretar los dientes)

VII Facial nerve VII Nervio facialCentral facial paresis Paresis facial centralPeripheral facial paresis Paresis facial lateral

A PUBLICATION OF THE MEDICAL DIVISION OF ATA NEUROLOGICAL EXAMINATION | 26

English → Spanish Glossary

VIII Vestibulocochlear nerve VIII Nervio auditivoCrude hearing test Prueba rudimentaria de la audiciónNystagmus Nistagmo

End point nystagmus, end position Nistagmo de posición terminalRotary nystagmus Nistagmo rotatorio

Past pointing test Prueba de señalización pasada o de past-pointing

Romberg’s test Prueba de RombergUnterberger’s test, stepping test Prueba de UnterbergerIX Glossopharyngeal nerve,X vagus nerve

IX Nervio glosofaríngeo,X Nervio vago

Gag reflex Reflejo nauseosoPalatine reflex Reflejo palatinoPalatine paralysis Parálisis palatinaXI Accessory nerve XI Nervio espinalStrength (force) of trapezius and sternocleidomastoidmuscles

Fuerza de músculos trapecios yesternocleidomastoideos

XII Hypoglossal nerve XII Nervio hipoglosoParalysis of the tongue, glossoplegia Parálisis lingualAtrophy of the tongue Atrofia lingual

MOTOR FUNCTION MUSCLES FUNCIÓN MOTORA – MÚSCULOSTrophicity TrofismoAtrophy AtrofiaMuscle tone Tono muscular

spasticity Espasticidadrigor, rigidity Rigor, rigidezflaccid muscle tone Tono muscular flácido

Involuntary movements Movimientos involuntariosTremor Temblorchoreatic movements Movimientos típicos de coreadystonic movements Movimientos distónicosfasciculations Fasciculaciones

Strength Fuerzaparesis = incomplete paralysis, Paresis = parálisis incompleta

weakness Debilidad

NEUROLOGICAL EXAMINATIONENGLISH

EXAMEN NEUROLÓGICOESPAÑOL

A PUBLICATION OF THE MEDICAL DIVISION OF ATA NEUROLOGICAL EXAMINATION | 27

English → Spanish Glossary

paralysis = loss or impairment of motor function Parálisis = pérdida o defecto de la funciónmotora

hemiparesis Hemiparesis

hemiplegia Hemiplejia

quadriparesis, tetraparesis Tetraparesis

tetraplegia Tetraplejía

Diadochokinesis Diadococinesia

normal diadochokinesis Diadococinesia normal

dysdiadochokinesis Disdiadococinesia

Testing for pronator drift Prueba de desviación del pronador

Reflexes, upper extremities Reflejos de extremidades superiores

biceps reflex Reflejo del bíceps

triceps reflex, elbow jerk Reflejo del tríceps, contracción del codo

brachioradial reflex Reflejo braquioradial

Reflexes, lower extremities Reflejos de extremidades inferiores

patellar reflex, quadriceps reflex, knee jerk Reflejo rotular, contracción de la rodilla,reflejo del cuádriceps

Achilles reflex, triceps surae reflex, Reflejo del tendón de Aquiles, reflejo deltríceps sural

ankle jerk Reflejo de contracción del tobillo

Reflexes are elicited and are: Se comprobaron los reflejos yresultaron:

normal Normales

brisk Enérgicos

exaggerated, hyperactive exagerados, hiperactivos

hyperactive with clonus hiperactivos con clonusdiminished, hypoactive disminuidos, hipoactivos

absent Ausentes

Pyramidal signs, upper extremities Signos piramidales, extremidadessuperiores

Trömner’s sign, Trömner’s reflex Signo o reflejo de Trömner

Hoffmann’s sign Signo de Hoffmann

NEUROLOGICAL EXAMINATIONENGLISH

EXAMEN NEUROLÓGICOESPAÑOL

A PUBLICATION OF THE MEDICAL DIVISION OF ATA NEUROLOGICAL EXAMINATION | 28

English → Spanish Glossary

Pyramidal signs, lower extremities Signos piramidales, extremidadesinferiores

Babinski’s reflex, Babinski’s sign, Signo o reflejo de Babinskiplantar reflex Reflejo cutáneo plantarOppenheim’s reflex Reflejo de Oppenheim

SENSIBILITY, SENSORY FUNCTION SENSIBILIDAD, FUNCIÓN SENSITIVASuperficial sensibility, superficial sensoryfunction

Sensibilidad superficial, funciónsensitiva superficial

touch sensation, tactile sensation Sensación al tacto, sensibilidad táctil(tactile) hypoesthesia Hipoestesia(tactile) hyperesthesia Hiperestesia

Temperature sense, thermesthesia Sensibilidad a la temperatura,termestesia

thermhypesthesia Hipoestesia térmicathermanesthesia Anestesia térmicathermhyperesthesia Hiperestesia térmica

Pain sense, nociperception Sensibilidad al dolor, nocipercepciónhypalgesia, hypoalgesia, hypalgia Hiperalgesia, hipoalgesia, hiperalgiahyperalgesia HiperalgesiaDissociated (dissociation) anesthesia Anestesia disociada

Vibration sense Sensibilidad a la vibraciónPosition sense Sentido de posición, propiocepciónTwo point discrimination Distinción entre dos puntos

COORDINATION COORDINACIÓNFinger-to- nose test Prueba de dedo a narizFinger-to-finger test Prueba de dedo a dedoHeel-to-knee test Prueba de talón a rodilla

GAIT MARCHAAssociated arm movements Movimientos coordinados de brazosToe walking Marcha de puntapiésHeel walking Marcha sobre talonesBlind gait, blind walking Marcha ciega, andando ciegoStraight line walking Marcha en línea rectaSpastic gait Marcha espásticaSteppage gait Marcha en estepajeAtaxic gait Marcha atáxicaSmall step gait, small step walking Marcha de pequeños pasos