The pre-analytical process management status and influencing factors of laboratory test before prescribing antimicrobial in developing country.

INTRODUCTION: The results of laboratory testing are crucial basis for clinicians to prescribe antimicrobial. Laboratory testing is a highly complex process, and increasing evidence suggests that errors and obstacles in the pre-analytical process (PP) will affect reasonable antimicrobial use. However, PP was an easily neglected link in hospital infection management and the current situation of it and the influencing factors of management are not clear. METHODS: A cross-sectional survey was conducted in the department of clinical, specimen collection, transportation, and inspection in 109 secondary and tertiary hospitals in Central China. The rate of antimicrobial susceptibility test request (AST) and related indexes of above departments were calculated to describe the situation. Management characteristics (frequency of training etc.) were described as proportions and fractional probit regression analysis was used to determine the influencing factors. RESULTS: The average rate of non restricted-use antimicrobial was 63%, the restricted-use was 86%, the special-use was 95%. The zero obstacle rate of specimen collection was 27.3%, of specimen transportation was 19.4% and of inspection feedback was 61.7%. There was a difference between the secondary and tertiary hospitals on non restricted-use (X2 = 22.968, P < 0.001); restricted-use (X2 = 29.466, P < 0.001); special-use (X2 = 27.317, P < 0.001). Taking non restricted-use as an example, training (OR = 0.312, 95%CI: 0.148,0.429), low-frequency appraisal (OR = 0.153, 95%CI: 0.082,0.224), guidance (OR = 0.32, 95%CI: 0.237,0.403) and information technology (OR = 0.104, 95%CI: 0.009,0.199) were positive factors. CONCLUSIONS: There were substantial differences in the rate of AST request in clinical department between secondary and tertiary hospitals. The zero obstacle rate in collection, transportation and inspection department were still low. In most departments, training and performance appraisal were positive factors, guidance and information technology were positive supporting factors.

The neural pattern of intuitive and analytical processes in the subliminal environment: N2 responses on the embedded Chinese character task.

Dual process theory proposes that there are two different types of human thinking: an intuitive process and an analytical process. However, if these two types of thinking could maintain their characteristics in the subliminal environment, further exploration of their relationship is required. This study used the Embedded Chinese Character Task (ECCT) with event-related potentials to investigate the behavioral and neural patterns of the intuitive and analytical processes in the subliminal environment. In this task, one Chinese character (target character) was extracted from another character (test character) with problem solving that required either an intuitive process (in which the two characters were spatially separated or adjacent) or analytical process (in which the target characters were embedded in the test characters). Participants were asked to judge whether the target character was included or excluded from the test character in the subliminal environment. Results showed that a difference in reaction time occurred between inclusion and exclusion only in the analytical materials, but there was a difference in N2 between the inclusion and exclusion conditions in both intuitive and analytical materials, indicating that participants preferred to choose intuitive processing to solve intuitive and analytical problems in an unconscious environment. These findings support the traditional dual process theory, which states that the intuitive process is unconscious and effortless, while the analytical process may perform like an intuitive process in a subliminal environment.

El cumplimiento del procedimiento pre-analítico contribuye a la seguridad del paciente. Laboratorio clínico primer nivel de atención. Distrito 09d17-milagro-salud. 2018-2019 / Compliance with the pre-analytical procedure contributes to the safety of the patient. Clinical laboratory first level of care. District 09d17-Milagro-Salud. 2018-2019

El procedimiento pre-analítico en el laboratorio clínico es un conjunto de pasos que inician a partir de la orden de examen realizada por el médico, verificación de la identificación del paciente, criterios de aceptación y rechazo de la muestra, recolección de la muestra, identificación de la muestra, transporte seguro, en temperatura y tiempo apropiado. Luego ingresan para su preparación, y termina en el momento que se inicie con el análisis de las pruebas. Objetivos: Determinar el cumplimiento del procedimiento pre-analítico que contribuye a la seguridad del paciente en el laboratorio clínico. Método: El presente, es un estudio observacional, de tipo cuantitativo, de alcance descriptivo no experimental, de corte transversal. Resultados: de acuerdo a los resultados obtenidos de 112 muestras, con base a la ficha de observación, se logró evidenciar que ha habido muestras con calidad inadecuada como son las hemolizadas, coagulas y contaminadas. Y por estar en esas condiciones, son rechazadas por el laboratorio clínico, lo que conlleva a que se realice otra toma en el paciente, causando malestar, demora en la entrega de sus resultados e insatisfacción. También se evidencia que las muestras hemolizadas son mayores a las coaguladas y contaminadas. Conclusión: Este estudio ha ayudado a conocer que en los puestos de toma de muestra no se está implementando las normas de calidad para evitar errores que han estado causando malestar en los pacientes. Así como también, los puestos de toma de muestra no disponen de equipos para ayudar a conservar las muestras y trazabilidad de sus análisis(AU)

The pre-analytical procedure in the clinical laboratory is a set of steps that start from the order of examination carried out by the doctor, verification of the patient's identification, criteria for acceptance and rejection of the sample, collection of the sample, identification of the sample, safe transport, at appropriate temperature and time. Then they enter for their preparation, and it ends when the analysis of the tests begins. Objectives: To determine compliance with the pre-analytical procedure that contributes to patient safety in the clinical laboratory. Method: This is an observational, quantitative, descriptive, non-experimental, cross-sectional study. Results: according to the results obtained from 112 samples, based on the observation file, it was possible to show that there have been samples with inadequate quality such as hemolizada, coagulated and contaminated ones. In addition, because they are in these conditions, the clinical laboratory the clinical laboratory rejected them, which leads to another taking in the patient, causing discomfort, delay in the delivery of results and dissatisfaction. It is also evident that hemolizada samples are greater than those that are coagulated and contaminated. Conclusion: This study has helped to know that in the sampling stations not implemented quality standards to avoid errors that have been causing discomfort in patients. As well as, the sampling stations do not have equipment to help conserve the samples their traceability and analyzes(AU)

[Mastering the analytical process of the Complete Blood Count: how and why?] / Maîtrise du processus analytique de la Numération Formule Sanguine : comment et pourquoi ?

This is a prospective study realized at the level of the hematology department and blood transfusion center of the University Hospital Center (CHU) of Dr Ben Badis of Constantine and spread out over a period of one year (from January 1st to December 31st). The work focused on the analytical processes mastery of the NFS needs a compulsory step concerning technical and organizational laboratory skills respecting the ISO 15189 laws going through a mastery of support processes (humain resourses, informatics, materials, documents, management) indispensable for the good function of analytic proceedings, a performance evaluation of the hematology analyzer Advia (2120 I and II and 560) and quality control management (intern, extern). The analytic performance evaluation of Advia gives reliable results reproductible and stable for use of the routine automatisation good inter-machine correlation and laboratory performance in terms of the quality extern evaluation with military hospital laboratory.

Pre-, post- or no acidification of urine samples for calcium analysis: does it matter?

Background Measuring 24 h-urine calcium concentration is essential to evaluate calcium metabolism and excretion. Manufacturers recommend acidifying the urine before a measurement to ensure calcium solubility, but the literature offers controversial information on this pre-analytical treatment. The objectives of the study were (1) to compare pre-acidification (during urine collection) versus post-acidification (in the laboratory), and (2) to evaluate the impact of acidification on urinary calcium measurements in a large cohort. Methods We evaluated the effects of pre- and post-acidification on 24-h urine samples collected from 10 healthy volunteers. We further studied the impact of acidification on the calcium results for 567 urine samples from routine laboratory practice, including 46 hypercalciuria (≥7.5 mmol/24 h) samples. Results Calciuria values in healthy volunteers ranged from 0.6 to 12.5 mmol/24 h, and no statistical significance was found between non-acidified, pre-acidified and post-acidified conditions. A comparison of the values (ranging from 0.21 to 29.32 mmol/L) for 567 urine samples before and after acidification indicated 25 samples (4.4%) with analytical differences outside limits of acceptance. The bias observed for these deviant values ranged from -3.07 to 1.32 mmol/L; no patient was re-classified as hypercalciuric after acidification, and three patients with hypercalciuria were classified as normocalciuric after acidification. These three deviant patients represent 6.5% of hypercalciuric patients. Conclusions Our results indicate that pre- and post-acidification of urine is not necessary prior to routine calcium analysis.

Continual improvement of the pre-analytical process in a public health laboratory with quality indicators-based risk management.

Background Quality indicators (QIs) and risk management are important tools for a quality management system designed to reduce errors in a laboratory. This study aimed to show the effectiveness of QI-based risk management for the continual improvement of pre-analytical processes in the Kayseri Public Health Laboratory (KPHL) which serves family physicians and collects samples from peripheral sampling units. Methods QIs of pre-analytical process were used for risk assessment with the failure modes and effects analysis (FMEA) method. Percentages and risk priority numbers (RPNs) of QIs were quantified. QI percentages were compared to the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) performance specifications and RPNs were compared to risk level scale, and corrective actions planned if needed. The effectiveness of risk treatment actions was re-evaluated with the new percentages and with RPNs of predefined QIs. Results RPNs related to four QIs required corrective action according to the risk evaluation scale. After risk treatment, the continual improvement was achieved for performance and risk level of "transcription errors", for risk levels of "misidentified samples" and "not properly stored samples" and for the performance of "hemolyzed samples". "Not properly stored samples" had the highest risk score because of sample storage and centrifugation problems of peripheral sampling units which are not under the responsibility of the KPHL. Conclusions Public health laboratories may have different risk priorities for pre-analytical process. Risk management based on predefined QIs can decrease the risk levels and increase QI performance as evidence-based examples for continual improvement of the pre-analytical process.

Progress of analytical tools and techniques for human gut microbiome research.

Massive DNA sequencing studies have expanded our insights and understanding of the ecological and functional characteristics of the gut microbiome. Advanced sequencing technologies allow us to understand the close association of the gut microbiome with human health and critical illnesses. In the future, analyses of the gut microbiome will provide key information associating with human individual health, which will help provide personalized health care for diseases. Numerous molecular biological analysis tools have been rapidly developed and employed for the gut microbiome researches; however, methodological differences among researchers lead to inconsistent data, limiting extensive share of data. It is therefore very essential to standardize the current methodologies and establish appropriate pipelines for human gut microbiome research. Herein, we review the methods and procedures currently available for studying the human gut microbiome, including fecal sample collection, metagenomic DNA extraction, massive DNA sequencing, and data analyses with bioinformatics. We believe that this review will contribute to the progress of gut microbiome research in the clinical and practical aspects of human health.

LC-MSMS assays of urinary cortisol, a comparison between four in-house assays.

BACKGROUND: Twenty-four hour urinary free cortisol (UFC) determination can be used for screening and follow-up of Cushing syndrome (CS). As immunoassay methods lack specificity for UFC measurement, the use of high-performance liquid chromatography coupled to mass spectrometer (LC-MSMS) is recommended. The aim of our study was to compare UFC results using four LC-MSMS methods performed in four independent laboratories in order to evaluate interlaboratory agreement. METHODS: Frozen aliquots of 24-h urine samples (78 healthy volunteers and 20 patients with CS) were sent to four different laboratories for analysis. Following liquid-liquid or solid-liquid extraction, UFC were determined using four different LC-MSMS assay. RESULTS: UFC intra- and interassays variation coefficients were lower than 10% for each centre. External quality control results were not significantly different. UFC normal ranges (established from healthy volunteers) were 17-126, 15-134, 12-118 and 27-157 nmol/day, respectively. Classification of UFC from healthy volunteers and patients with CS using a 95th percentile threshold was similar. However, for extreme UFC values (<50 or >270 nmol/day), negative or positive bias was noted. CONCLUSIONS: Even for highly specific methods such as LC-MSMS, variations of results can be found depending on analytical process. Validation of LC-MSMS methods including determination of the reference range is essential.

Passos, manchas e traços / Steps, spots and traces

Tomando como ponto de partida o livro de contos do poeta e escritor português Herberto Helder, a autora traça um paralelo entre a presença do corpo na escrita e no processo de análise.

On the path of the short stories written by the Portuguese poet and writer Herberto Helder, the author draws a parallel between the presence of the body in the literature and in the analytical process.

Relato sobre el proceso psicoanalítico de un niño diagnosticado tempranamente: “¿y si Lucas tiene autismo? / A story about the psychoanalytic process of early diagnosis of a child: “what if lucas has autism?”

El artículo intenta transmitir una modalidad de trabajo clínico construida a partir de un modo de pensamiento psicoanalítico, a través del relato de un niño que fue diagnosticado a los dos años y seis meses con un retraso en su desarrollo. El recorrido da cuenta de un proceso analítico de cuatro años que llegó a su término incluyendo a los padres en dicho trabajo, pudiendo favorecer el crecimiento del niño, el despliegue del lenguaje verbal y la restitución de un vínculo tempranamente afectado.

The article attempts to transmit a form of clinical work built from a psychoanalyticway of thinking, through the story of a child who was diagnosed with adevelopmental delay at two and a half years of age. The journey conductsa four year analytical process that came to an end including parents in suchwork, being able to promote the growth of the child, the deployment of hisverbal language and the restoration of an earlier affected link.

L’article a l’objectif de transmettre une modalité de travail clinique construiteà partir d’un mode de pensée psychanalytique à travers le récit d’un enfantque fut diagnostiqué d’un retard dans son développement à l’âge de deuxans et six mois. Le parcours rend compte d’un procès analytique de quatreans qui est arrivé à son terme avec la inclusion de ses parents dans ce travail,permettant d’aider la croissance de l’enfant, le déploiement de la langueverbal et la restitution d’un lien affecté depuis très tôt.

Influence of diet and sample collection time on 77 laboratory tests on healthy adults.

OBJECTIVES: We studied the effect of a standardized breakfast or lunch before blood sampling on 77 analytes. DESIGN AND METHODS: The mean difference between assays from 20 healthy adults was calculated on blood samples taken before and after food intake. Significant differences were tested using two-tailed Student t-test and compared to the acceptable limits derived from analytical and intraindividual biological variation. RESULTS: Most of the analytes investigated were not significantly affected by food intake. Six of them were influenced by breakfast or lunch: triglycerides, glucose, creatinine, C-peptide and insulin were significantly upregulated, whereas testosterone was downregulated. Fourteen parameters were more influenced by time of sampling than by meals: nine decreased during the day (total bilirubin, BNP, myoglobin, cortisol, TSH, C-telopeptide, prolactin, ACTH, uric acid) and two increased (white blood cells, neutrophils). Three parameters showed levels that were similar at 9:00 am and 5:00 pm but their lowest level at 12:30 pm (inorganic phosphorus, osteocalcin, PTH). CONCLUSIONS: Fasting is necessary for some laboratory tests. Clinicians should be aware of variations due to sampling time before ordering non-fasting tests, and in the subsequent interpretation of results.

Tecendo o tempo: algumas reflexões sobre as ideias de Danielle Quinodoz a partir de uma história infantil / Weaving time: some reflections on the ideas of Danielle Quinodoz from a children's story

As reflexões deste trabalho partem de um livro infantil de Gláucia de Souza, que conta a história de uma geração de mulheres que tecem roupas, toalhas, colchas e agasalhos para o enxoval das filhas, constituindo, assim, uma tradição familiar, até chegar a uma geração onde acontecem algumas mudanças e uma personagem - Tecelina - assume a história. A partir dessa ilustração, a autora entrelaça uma revisão de algumas idéias de Danielle Quinodoz sobre a passagem do tempo, o envelhecer e os "segundos de eternidade" para pensar a vida e, também, o processo analítico, onde, em um setting capaz de acolher a dor da alma, paciente e terapeuta tecem agasalhos simbólicos, com palavras.

The autor's reflections are based upon a children's book by Glaucia Souza - which tells the story of a generation of women who weave clothes, towels, quilts and warm clothing for their daughters' layettes. Their weaving constitutes a family tradition, which remains the same untill some changes take place and a new character named Tecelina takes the story on. Based upon this illustration, the author weaves a review of Danielle Quinodoz's ideas about the passage of time, aging and "seconds of eternity" in order to reflect about life and the analytical process, where both patient and analyst can make room for pain in the soul by weaving sweaters with words

Os limites do setting psicanalítico: uma revisão do “ambiente” necessário para a escuta e evolução do processo analítico / The limits of the psychoanalytical setting: a review of the necessary ambient to the listening and evolution of the analytical process

A autora tece algumas considerações sobre o setting analítico. Destaca o seu valor como o ambiente necessário para a escuta do paciente e o favorecimento do processo analítico. O setting ou enquadre inclui as condições formais do encontro analítico e fundamentalmente a atitude mental do analista. Utilizam-se nesta reflexão principalmente os pensamentos de Bion, Ferro, Winnicott e Green(AU)

The author presents some considerations about the analytic setting. She highlight its value as the necessary environment for listening to the patient and facilitating the analytical process. The setting includes the formal characteristics of the analytic encounter and especially the mental attitude of the analyst. This discussion is based mainly on Bion, Ferro, Winnicott and Green(AU)

Primeiras entrevistas: qual é a demanda? / First interviews: what is the demand? / Primeras entrevistas: ¿cuál es la demanda?

A autora faz um apanhado histórico das primeiras entrevistas em psicanálise, desde Freud até autores contemporâneos. Propõe as primeiras entrevistas como necessárias para identificar qual é a demanda da pessoa que busca tratamento, de modo a não se produzir um engano para ambos da dupla.

The author presents a historical overview of the first interviews in psychoanalysis, from Freud to contemporary authors. The initial interviews are considered necessary to identify what the demand of the person seeking treatment is, lest it be a mistake for both patient and analyst.

La autora hace un recorrido histórico por las primeras entrevistas en psicoanálisis, desde Freud hasta los autores contemporáneos. Propone las primeras entrevistas como necesarias para identificar cuál es la demanda de la persona que busca tratamiento, para que no se produzca un equívoco entre la dupla.

Psicanálise: a clínica e o projeto transferencial / Psychoanalysis: practice and the transference project / Psicoanálisis: la clínica y el proyecto transferencial

O autor objetiva propor algumas considerações sobre o processo psicanalítico, sobretudo no que se refere a como ele começa e quais são as suas condições para começar. Examinando o texto freudiano, mais especificamente os denominados textos técnicos de 1914, sugere que esse processo começa por uma relação de sedução inconsciente vinda do analista/terapeuta e, mesmo, da própria situação analítica. Do lado do paciente, por sua vez, o autor propõe a ideia de um projeto transferencial, algo construído pelo paciente, composto de fantasmas, de um lado, e de representações-meta conscientes, de outro, no qual o analista tem designado um lugar. Se o analista recusa-se a participar desse projeto, a análise/psicoterapia não se inicia de fato.(AU)

The author aims to propose some considerations on the psychoanalytical process, particularly with regard to the start of the process and its conditions for starting. By examining Freudian texts - specifically the so-called 1914 technical papers - he suggests that this process begins with a non-conscious seductive relationship started by the analyst/therapist, and even from the analytical situation itself. On the part of the patient, the author proposes the idea of a transference project, something constructed by the patient, consisting of specters on one hand, and by purposive ideas on the other, wherein the analyst/therapist has a designated role. If the analyst/therapist refuses to participate in the project, analysis/psychotherapy does not truly begin.(AU)

El autor propone algunas consideraciones sobre el proceso psicoanalítico, sobretodo en relación a como empieza y cuales son sus condiciones para empezar. Examinando el texto freudiano, más precisamente los llamados textos técnicos de 1914, sugiere que esse proceso comienza por una relación de seducción inconsciente, que viene del analista/terapeuta y aun de la propia situación analítica. De la parte del paciente, por sun lado, el autor plantea la idea de un proyecto transferencial, algo construido por el paciente, compuesto, por un lado, por fantasmas, y, por otro, por representaciones-meta conscientes, en lo cual el analista tiene un lugar desinado. Si el analista se recusa a participar de esse proyecto, el análisis/psicoteria no comienza de hecho.(AU)

Psicanálise: a clínica e o projeto transferencial / Psychoanalysis: practice and the transference project / Psicoanálisis: la clínica y el proyecto transferencial

O autor objetiva propor algumas considerações sobre o processo psicanalítico, sobretudo no que se refere a como ele começa e quais são as suas condições para começar. Examinando o texto freudiano, mais especificamente os denominados textos técnicos de 1914, sugere que esse processo começa por uma relação de sedução inconsciente vinda do analista/terapeuta e, mesmo, da própria situação analítica. Do lado do paciente, por sua vez, o autor propõe a ideia de um projeto transferencial, algo construído pelo paciente, composto de fantasmas, de um lado, e de representações-meta conscientes, de outro, no qual o analista tem designado um lugar. Se o analista recusa-se a participar desse projeto, a análise/psicoterapia não se inicia de fato.

The author aims to propose some considerations on the psychoanalytical process, particularly with regard to the start of the process and its conditions for starting. By examining Freudian texts - specifically the so-called 1914 technical papers - he suggests that this process begins with a non-conscious seductive relationship started by the analyst/therapist, and even from the analytical situation itself. On the part of the patient, the author proposes the idea of a transference project, something constructed by the patient, consisting of specters on one hand, and by purposive ideas on the other, wherein the analyst/therapist has a designated role. If the analyst/therapist refuses to participate in the project, analysis/psychotherapy does not truly begin.

El autor propone algunas consideraciones sobre el proceso psicoanalítico, sobretodo en relación a como empieza y cuales son sus condiciones para empezar. Examinando el texto freudiano, más precisamente los llamados textos técnicos de 1914, sugiere que esse proceso comienza por una relación de seducción inconsciente, que viene del analista/terapeuta y aun de la propia situación analítica. De la parte del paciente, por sun lado, el autor plantea la idea de un proyecto transferencial, algo construido por el paciente, compuesto, por un lado, por fantasmas, y, por otro, por representaciones-meta conscientes, en lo cual el analista tiene un lugar desinado. Si el analista se recusa a participar de esse proyecto, el análisis/psicoteria no comienza de hecho.

Da delicada complexidade do encontro analítico / On the delicate complexity of the analytical encounter / La delicada complejidad del encuentro analítico

Considerando a relação analítica um desafio e um desconhecido a ser vivenciado, o texto destaca a importância do analista como pessoa e a sua interferência organizadora no funcionamento mental do analisando e em todo o desenrolar do processo de análise levando em conta as possibilidades e os limites da dupla.

Departing from the idea of the analytical relationship as a challenge and an unknown to be experienced, the article highlights the significance of the analyst as an individual and his/her organizational interference in the mental functioning of the patient and in the unfolding of the analytical process, taking into account the possibilities and limitations of the couple.

Considerando la relación analítica un desafío y una experiencia a ser vivida, el texto destaca la importancia del analista como persona y su interferencia organizadora en el funcionamiento mental del analizado, y en todo el desarrollo del proceso de análisis, teniendo en cuesta las posibilidades y los límites del par analítico.

Sobre a ação terapêutica da psicanálise no século XXI / Sobre la acción terapéutica del psicoanálisis en el siglo XXI / Regarding the therapeutic action of psychoanalysis in the 21st century

A fim de apoiar a ideia de que a psicanálise atualmente faz parte do processo de civilização, a autora examina a noção de ação terapêutica da psicanálise à luz de importantes obras freudianas. Também discute a contribuição de alguns pensadores seguidores de Freud, como Klein, Bion, Green, Lacan e a influência deles. Ela considera que a psicanálise é um método único com condições de resistir aos ataques contra o pensamento que precisamos enfrentar atualmente.(AU)

Con el fin de apoyar la idea de que el psicoanálisis actualmente forma parte del proceso civilizatorio la autora examina la noción de la acción terapéutica del psicoanálisis a la luz de importantes obras freudianas. Ella también discute la contribución de algunos pensadores seguidores de Freud como Klein, Bion, Green, Lacan y la influencia de ellos. Ella considera que el psicoanálisis es un método único con condiciones de resistir a los ataques contra el pensamiento que precisamos enfrentar actualmente.(AU)

In order to support the idea that psychoanalysis currently is part of the process of civilization, the author examines the notion of therapeutic action within psychoanalysis in light of important Freudian work. She also discusses the contributions of some thinkers, Freud followers such as Klein, Bion, Green, Lacan and their influence. she believes that psychoanalysis is a unique method with the means to resist the attacks agains the thought that we must face currently.(AU)

Sobre a ação terapêutica da psicanálise no século XXI / Sobre la acción terapéutica del psicoanálisis en el siglo XXI / Regarding the therapeutic action of psychoanalysis in the 21st century

A fim de apoiar a ideia de que a psicanálise atualmente faz parte do processo de civilização, a autora examina a noção de ação terapêutica da psicanálise à luz de importantes obras freudianas. Também discute a contribuição de alguns pensadores seguidores de Freud, como Klein, Bion, Green, Lacan e a influência deles. Ela considera que a psicanálise é um método único com condições de resistir aos ataques contra o pensamento que precisamos enfrentar atualmente.

Con el fin de apoyar la idea de que el psicoanálisis actualmente forma parte del proceso civilizatorio la autora examina la noción de la acción terapéutica del psicoanálisis a la luz de importantes obras freudianas. Ella también discute la contribución de algunos pensadores seguidores de Freud como Klein, Bion, Green, Lacan y la influencia de ellos. Ella considera que el psicoanálisis es un método único con condiciones de resistir a los ataques contra el pensamiento que precisamos enfrentar actualmente.

In order to support the idea that psychoanalysis currently is part of the process of civilization, the author examines the notion of therapeutic action within psychoanalysis in light of important Freudian work. She also discusses the contributions of some thinkers, Freud followers such as Klein, Bion, Green, Lacan and their influence. she believes that psychoanalysis is a unique method with the means to resist the attacks agains the thought that we must face currently.