Assertion Training and Human Relations Training in the Treatment of Chronic Alcoholics

The effects of milieu therapy plus assertion training were compared to those of milieu therapy plus human relations training in reducing drinking behavior and increasing interpersonal skills of skill-deficient, chronic alcoholics in an alcoholic rehabilitation center. Although both treatments led to comparable sobriety rates at a 6-week follow-up, the treatment group which contained assertion training demonstrated significant gains in interpersonal skills as compared to the treatment group which contained human relations training. A 2-year follow-up indicated that the assertion training group maintained sobriety significantly longer than the human relations training group.     

Social skills training for alcoholics and drug addicts: A review

Investigations that have employed social skills training with skill impaired alcoholics and drug addicts are reviewed. General definitions of assertion and social skill and research related to social skills acquisition are presented. While use of skills training with these populations is at an exploratory stage, preliminary findings suggest the utility of this approach for enhancing interpersonal performance. However, these results should be interpreted with caution due to various methodological problems. Generalization and maintenance of training, transfer measures, interaction between treatment components and subject characteristics, and validity of role played assessment procedures are all areas that warrant further attention. Usefulness of a more global social skills concept and approach also is discussed; suggestions for future directions of research are offered.     

Which Lesson Components Mediate Refusal Assertion Skill Improvement in School-Based Adolescent Tobacco Use Prevention?

Any of three components of current school-based refusal assertion training might mediate improvement of seventh grade students' ability to refuse tobacco use offers: 1) teaching students knowledge of ways to say “no,” 2) engaging students in the practice of refusal assertion, or 3) motivating students to perform refusal assertion in a socially skilled way. A 3-condition true field experimental “component study” of the differential effects of these three components yielded improvement in role-played behavioral skill to refuse tobacco offers that was evident in both the Knowledge and Practice conditions but not in the Motivation condition. In these same two conditions, skills training led to a significant decrease in students' intention to use smokeless tobacco in the future but not cigarettes. A focus on engaging students in Knowledge and Practice components of refusal assertion training appears warranted.     

Role of effective teamwork and communication in delivering safe, high-quality care

Healthcare is delivered in an extraordinary complex environment. Despite highly skilled, dedicated clinicians, there are currently unacceptably high levels of communication failures and adverse events. Effective teamwork, in conjunction with reliable processes of care, is essential for the consistent delivery of high-quality care. Practical concepts and tools are provided that address the team behaviors of structured communication, effective assertion/critical language, psychological safety, situational awareness, and effective leadership. Examples of the mounting clinical evidence of improved patient outcomes and reduced harm resulting from effective teamwork training are cited.     

Expectations regarding the effects of alcohol on assertiveness: A comparison of alcoholics and social drinkers

Twenty male alcoholics and 20 male social drinkers were compared on the Rathus Assertiveness Schedule (RAS) and the Assertion Questionnaire (AQ). In order to investigate expectancies regarding the effects of excessive drinking on assertiveness, these groups were compared under instructional sets requiring assumed sobriety and assumed intoxication. Analysis of the RAS data indicated that the assertion scores for alcoholics increased significantly across instructional sets, with higher scores occurring in the intoxicated set. In contrast, the RAS assertion scores for social drinkers were not influenced by the instructional set manipulation. On the AQ general assertion subscale, the assertion scores of the alcoholics again increased significantly across instructional sets, with the higher scores occurring in the intoxicated set. The AQ general assertion scores of the social drinkers did not vary. A different pattern of results was obtained on the AQ subscale measuring assertion toward authority. While social drinkers reported significantly higher assertion in the intoxicated instructional set, the scores for alcoholics did not vary. This research demonstrates important differences between alcoholics and social drinkers regarding their expected assertiveness following excessive drinking.     

Psychometric properties and social correlates of assertion measures in chronic alcoholics

Assertion is a major focus of many social skills interventions for alcoholics. The assessment of assertion often relies on self-report measures. However, few psychometric data are available on the most frequently used instruments. This study determined the internal characteristics and structure of two commonly employed measures of assertion: the Wolpe-Lazarus Assertion Inventory and the Callner-Ross Assertion Inventory. In addition, the relationship between responses on these devices and demographic variables, extent of substance abuse, and level of social functioning were examined. Results indicated that both inventories exhibit adequate internal consistency and test-retest reliability. Factor structures were relatively simple and represented general assertion situations. Results are discussed in terms of the need for further refinement of these instruments.     

Blinded independent central reviews: The FDA weighs in

Abstract

The FDA has recently issued a draft Guidance Standard for Clinical Trial Imaging Endpoints, which focuses on how to perform registration trials with imaging as an end-point or using imaging to determine patient eligibility. Leading up to the release of the guidance document, a major question was how the FDA viewed the value proposition of a blinded independent central review (BICR) of imaging data. The FDA states that a BICR is recommended in situations where clinical site image interpretation is variable and results of image measurements are important for eligibility determination, safety and/or efficacy end-points. This recommendation is based on the agency’s assertion that the centralized process can better provide verifiable and uniform reader training, as well as ongoing management of reader performance, ensuring that the process is accurate and that bias and variability are minimized. In addition to a review of the guidance document, this article will discuss a decision tree algorithm for determining when and what type of BICR should be performed, the relationship between bias (accuracy), variability and blinding paradigms, along with criteria for using BICRs to interpret non-imaging subjective clinical trial data.     

Challenges and opportunities of group therapy for adolescent substance abuse: a critical review

Group intervention has been the most commonly employed treatment modality for adolescents with substance use disorders (SUD). Evidence has been accumulating in support for the efficacy of diverse forms of group therapy that have been utilized with adolescents. It has been argued however, that aggregation of youths who display problem behavior into group interventions may, under some conditions, produce iatrogenic effects on all participants. This assertion known also as "deviancy training" and its presumed effect on treatment outcomes has created a barrier to progress regardless of the fact that it has not been tested or empirically supported in heterogeneous groups of adolescents treated for SUD. It is imperative to optimize group intervention while considering how to prevent, reduce and control, potentially iatrogenic effects associated with the aggregation of antisocial youths in heterogeneous groups. The main objective of this review is to address the challenges and opportunities regarding group treatment of adolescent SUD.     

Reversal of age-related cognitive impairments by an M1 cholinergic agonist, AF102B

This study examined the effect of a specific M1 cholinergic agonist, AF102B, on place learning of aged and young rats. Spatial reference memory was tested in the Morris Water Maze task, while spatial working memory was tested on an 8-arm radial maze. Both memory functions were impaired in aged rats compared to young animals. However, the administration of AF102B significantly reduced the age-related cognitive impairments observed in both tasks. This data supports the assertion of the "cholinergic hypothesis," namely that specific enhancement of cholinergic function may reverse geriatric cognitive deficits.     

The development and evaluation of an interdisciplinary health training program: a pharmacy perspective

This program integrates training with the clinical interdisciplinary aspects of health care by directly involving pharmacy and other health professional students in an on-going team model of health care delivery. The training program model allows pharmacy students to learn the conceptual basis of team care and to experience directly how this concept is applied in an ambulatory health care setting. Learning strategies include specialty and team delivery of health care, participation in weekly interdisciplinary team training seminars, involvement in problem-solving and other skill building activities, and development of an interdisciplinary team project. Program evaluation results have indicated that students perceive that the interdisciplinary training increased their knowledge and positive attitudes towards interdisciplinary teams. The training also increased their sensitivity to patients, and enhanced the understanding of the problems of delivering health care to an urban community. The results have also shown that through this structured interdisciplinary experience, students reported having a better understanding of the roles of other health professionals and a greater awareness of how these different roles are integrated into a health care team.     

A novel naloxone training compared with current recommended training in an overdose simulation

ObjectivesThe aim of this study was to determine if a novel naloxone training program with a focus on situational stress management yields better results than the currently recommended state training in a simulated overdose response.MethodsStudents were randomized to receive either the state training or a novel training developed by the Wilkes University Nesbitt School of Pharmacy. After their respective training, each student individually completed a live simulated overdose response with an added stressor of a panicked bystander. A checklist was used to evaluate students during the simulation, and the results were compared.ResultsThe average grade for the novel training students was 89% compared with 64% for the state training students (P < 0.001). There was no statistically significant difference in time to complete the simulation.ConclusionStudents who underwent the novel training received the state training. The novel training appears to be effective in preparing students to manage a live opioid overdose.     

Can pharmacy assistants play a greater role in public health programs in community pharmacies? Lessons from a chlamydia screening study in Canberra,Australia

BackgroundLittle is known about the engagement of pharmacy assistants (PA) in public health service provision.ObjectiveTo explore the experiences of PA participating in a study to determine whether a cash reward, offered to consumers and pharmacy businesses, increased participation in community pharmacy-based chlamydia screening.MethodsPA experience of the study education and training package, participant recruitment and conducting screening (providing information about chlamydia, specimen collection and handling urine samples) were evaluated using knowledge assessment, a questionnaire and focus groups.ResultsTwenty PA participated in the study: 15 (75%) completed all education and training components, 20 (100%) completed the questionnaire and 10 (50%) attended a focus group. PA rated all education and training components as effective (mean visual analog scale scores >8.5). Most PA (13/18, 72.2%) did not support/were unsure about continuing the program, citing the 25% repeat testing rate (presumed to relate to the cash reward) and privacy/confidentiality issues as reasons. Qualitative analysis suggested that minimizing repeat testing, improved workload management and recognition of, and remuneration for, education and training would make this model more acceptable to PA.ConclusionFindings from this study support the assertion that PA can play a significant role in public health initiatives.     

The timing of an injection procedure affects pharmacological actions on memory

In a series of experiments examining the effects of the protein synthesis inhibitor anisomycin on memory for a novel active avoidance task in mice, we found that the timing of administering the drug (pretraining or posttraining) affected its amnestic potency. Anisomycin injected after training was more effective than when injected before training. Adding a saline injection, such that all groups received both pre- and posttraining injections, resulted in greater amnesia with anisomycin given before rather than after training. These results indicate that the procedure of drug administration alters the effectiveness of amnestic agents.     

Effects of sodium barbitone on learning and memory-storage of an appetitive and an aversive task

In order to test the effects of sodium barbitone on the acquisition and retention of an appetitively and an aversively reinforced behavior, mice were trained in a spatial discrimination Y-maze task. Learning was observed in both situations, with acquisition unimpaired by the drug. Sodium barbitone did, however, affect retention of both tasks in all groups treated with the drug before training. Results are discussed in light of the various modes of action of this drug, i.e., as an inhibitor of protein synthesis, as a blocker of catecholamine biosynthesis, with regard to its effects on paradoxical sleep and on gamma-amino butyric acid (GABA).     

Construct validity analysis of the early smoking experience questionnaire for adolescents

Analysis was undertaken to assess the construct validity of a measure of early smoking experience with a sample of adolescent smokers who had ever tried smoking. The results of this study support a two-factor structure of early smoking experience as well as the assertion that initial smoking experience can be characterized by both unpleasant and pleasant sensations. A cross-structure analysis with related and unrelated constructs supports the convergent and discriminant validity of the measure for an adolescent population.     

Quality assurance and certification program for an aminoglycoside monitoring service

A Quality Assurance Program (QAP) should both evaluate and improve the quality of a service. In order to train newly employed pharmacists and ensure provision of a consistently high level of clinical service, a pharmacist training program for an Aminoglycoside Monitoring Service (AMS) and a QAP involving pharmacist certification was established. The certification program consists of a pretest, a reading/information package, an "on the job" training requirement and a posttest which pharmacists work through at their own speed. Certification requires completion of 45 hours of supervised AMS activity and a score of 90 percent on the posttest. Yearly recertification is required. As an integral part of the QAP, the clinical coordinator reviews the AMS monitoring forms monthly for specific performance standard indicators. Problems are identified and dealt with on an individual basis. The program is not mandatory, however, all pharmacists have elected to complete certification. Seven pharmacists and three pharmacy residents have participated in the certification program. All seven pharmacists and one resident received certification. A questionnaire completed by the pharmacists indicated that all felt certification was necessary and contributed to standardization and consistency of the AMS.     

Impact of an oncology pharmacy residency training program on quality improvement initiatives in an oncology center

The concept of quality care is something every patient expects, regardless of how they enter the health care system. The specialty-trained oncology pharmacy practitioner possesses many skills to offer the patient and other health care practitioners. Oncology pharmacy residency training involves specific types of learning situations and experiences, which will be critical for future roles the specialty resident may assume. Oncology practice is an area requiring a high level of care for patients, and highly skilled pharmacy practitioners are crucial for the care of these patients.     

Functional interactions between cannabinoid and metabotropic glutamate receptors in the central nervous system

The recent appreciation that two G-protein-coupled receptors, metabotropic glutamate and cannabinoid, are trans-synaptically linked by a small lipid messenger has profound implications, both for control of synaptic transmission and for novel therapeutic strategies. There is much evidence for this assertion and on the significance of this dual receptor cooperation for modulation of synaptic transmission in the central nervous system.     

Generating and confirming hypotheses

Dr. Walker asserts that a hypothesis always can be tested using the same data source that generated the data if the test data are independent of the data generating the hypothesis. One way to do this is to use part of the totality of data to generate the hypothesis and the other to test the hypothesis. The validity of this assertion depends on what one means by ‘independent’. This note addresses the logical and statistical implications of Dr. Walker's assertion. The key conclusion is that what constititutes ‘independent’ data has to be considered carefully, and that hypothesis‐generating and test data from the same data source generally can not be considered ‘independent’. Copyright © 2010 John Wiley & Sons, Ltd.