1 + 1 = 3? The systematic development of a theoretical and evidence-based tailored multimedia intervention to improve medication adherence

Objective

To describe the development of a theoretical and evidence-based tailored multimedia intervention to improve medication intake behavior in patients with inflammatory bowel disease (IBD). The intervention integrates interpersonal and technology-mediated strategies with the expectation that this will work synergistically.

Methods

The development followed the Medical Research Council's framework. Three literature reviews and three pre-tests among 84 IBD patients and eight nurses were conducted to guide the development of the intervention. A feasibility study was carried out among four nurses and 29 patients.

Results

The components include: (1) an online preparatory assessment (OPA); (2) tailored interpersonal communication; and (3) tailored text messaging. To support the development, the feasibility was tested. Results indicated that the OPA was comprehensive and could be a helpful tool for both patients and nurses to prepare for the consultation. The training was evaluated as being instructive and applicable with a mean mark of 8.5. Of the developed messages, 65.6% received positive evaluations and were used in the intervention.

Conclusion

By applying the framework, we were able to describe the logic behind the development of a tailored multimedia intervention to improve medication intake behavior.

Practice implications

This study could serve as a guide for the development of other health interventions.     

中老年前列腺癌根治术后患者社会疏离现状及其影响因素分析

目的了解中老年前列腺癌根治术后患者社会疏离现状,探讨其影响因素。方法采用一般情况调查表、一般疏离感量表、简易应对方式量表、社会支持评定量表对210例中老年前列腺癌根治术患者进行横断面的调查。采用多重线性回归分析探讨影响中老年前列腺癌根治术后患者社会疏离的因素。结果中老年前列腺癌根治术后患者社会疏离得分为(44.48±11.57)分、积极应对得分(20.58±2.96)分、消极应对得分(18.24±4.57)分及社会支持得分(38.42±5.61)分。中老年前列腺癌根治术后患者社会疏离与积极应对方式、社会支持均呈负相关(P<0.001),与消极应对方式呈正相关(P<0.001)。多重线性回归分析结果显示,积极应对、消极应对、社会支持以及尿失禁是影响中老年前列腺癌根治术后患者社会疏离的主要因素,其可共同解释社会疏离得分总变异的46.90%。结论中老年前列腺癌根治术后患者社会疏离水平较高,尤其是有尿失禁症状、倾向于消极应对及社会支持较低的患者。提高患者控尿能力,增强其积极应对和社会支持及减轻其消极应对,可降低患者社会疏离水平。     

生物运动的人际交互辨识研究

目的：研究人际交互的辨识特征。方法向参与者播放19项人际互动刺激和8项非交流性对照刺激,要求参与者作答,再由评判员进行判断。结果(1)对交流行为识别率方面女性和男性点光源视频识别率做对比后发现“靠近点”这一动作识别率差异有统计学意义(χ2=21.52,P=0.001);(2)对社会动机识别率方面女性和男性点光源视频识别率做对比后发现,“不要”这一动作识别率存在显著性差异(χ2=8.66,P=0.003)。“哪一个？”这一动作存在显著性差异(χ2=8.37,P=0.004);(3)对具体姿势的识别率差异有统计学意义的是：“我很生气”(χ2=5.44, P=0.020)、“不要”(χ2=8.27,P=0.004)和“捡起来”(χ2=5.70,P=0.017)。结论我国大学生在互动交流识别方面的敏感性较高;在社会动机和姿势识别率方面部分动作和国外研究一致,部分不一致。     

1 + 1 = 3? The systematic development of a theoretical and evidence-based tailored multimedia intervention to improve medication adherence

ObjectiveTo describe the development of a theoretical and evidence-based tailored multimedia intervention to improve medication intake behavior in patients with inflammatory bowel disease (IBD). The intervention integrates interpersonal and technology-mediated strategies with the expectation that this will work synergistically.MethodsThe development followed the Medical Research Council's framework. Three literature reviews and three pre-tests among 84 IBD patients and eight nurses were conducted to guide the development of the intervention. A feasibility study was carried out among four nurses and 29 patients.ResultsThe components include: (1) an online preparatory assessment (OPA); (2) tailored interpersonal communication; and (3) tailored text messaging. To support the development, the feasibility was tested. Results indicated that the OPA was comprehensive and could be a helpful tool for both patients and nurses to prepare for the consultation. The training was evaluated as being instructive and applicable with a mean mark of 8.5. Of the developed messages, 65.6% received positive evaluations and were used in the intervention.ConclusionBy applying the framework, we were able to describe the logic behind the development of a tailored multimedia intervention to improve medication intake behavior.Practice implicationsThis study could serve as a guide for the development of other health interventions.     

“I just answer ‘yes’ to everything they say”: Access to health care for deaf people in Worcester,South Africa and the politics of exclusion

Objective

To explore whether there are other factors besides communication difficulties that hamper access to health care services for deaf patients.

Methods

Qualitative methodology using semi-structured interviews with 16 deaf participants from the National Institute for the Deaf in Worcester and 3 Key informants from the Worcester area, South Africa.

Results

Communication difficulties were found to be a prominent barrier in accessing health care services. In addition to this interpersonal factors including lack of independent thought, overprotectedness, non-questioning attitude, and lack of familial communication interact with communication difficulties in a way that further hampers access to health care services.

Conclusion

These interpersonal factors play a unique role in how open and accepting health services feel to deaf patients.

Practice implications

Health care services need to take cognizance of the fact that providing sign language interpreters in the health care setting will not necessarily make access more equitable for deaf patients, as they have additional barriers besides communication to overcome before successfully accessing health care services.     

ISBAR沟通训练对全科规范化培训住院医师沟通与团队合作能力的影响研究

背景　沟通合作是住院医师规范化培训（规培）的培训目标之一,提高全科规培住院医师的沟通意识、技巧及团队合作能力具有重要意义。ISBAR沟通训练模式能够有效提高医师的临床沟通能力和团队合作能力,将其应用于规培具有可行性。目的　探讨ISBAR沟通训练对全科规培住院医师的人际沟通与团队合作能力的影响。方法　选取于2017年9月开始于新乡医学院第一附属医院参加规培的全科学员100例,采用简单随机分组法将其分为对照组和观察组,每组50例。对照组学员采用传统临床带教方法,不进行任何沟通方式的培训;观察组学员在常规带教的基础上,进行ISBAR沟通训练。分别于培训前和培训2周后,采用“规培住院医师人际沟通能力评价量表”“规培住院医师合作能力评价量表”对两组学员进行调查;分别于培训前及培训3、6个月后,采用“医护合作态度量表”“医医合作态度量表”对两组学员进行调查,采用“医医沟通能力调查表”“医护沟通能力调查表”对两组学员的合作人员进行调查。结果　培训前,两组学员人际沟通能力、合作能力得分无统计学差异（P>0.05）;培训2周后,两组学员人际沟通能力、合作能力得分均高于培训前（P<0.05）,且观察组学员人际沟通能力、合作能力得分高于对照组（P<0.05）。培训前后两组学员医护合作态度、医护沟通能力得分比较,差异有统计学意义（P<0.05）;不同时间点比较,差异有统计学意义（P<0.05）;组别和时间在医护合作态度、医护沟通能力得分上存在交互作用（P<0.05）。培训前后两组学员医医合作态度、医医沟通能力得分比较,差异有统计学意义（P<0.05）;不同时间点比较,差异有统计学意义（P<0.05）;组别和时间在医医合作态度、医医沟通能力得分上存在交互作用（P<0.05）。结论　在规培阶段对学员进行ISBAR沟通训练,可以明显提高学员的人际沟通能力和团队合作能力。     

Interpersonal distress is associated with sleep and arousal in insomnia and good sleepers

Objective

The interpersonal environment is strongly linked to sleep. However, little is known about interpersonal distress and its association with sleep. We examined the associations among interpersonal distress, objective and subjective sleep in people with and without insomnia.

Methods

Participants in this cross-sectional observational study included men and women with insomnia (n = 28) and good sleeper controls (n = 38). Interpersonal distress was measured with the Inventory of Interpersonal Problems. Sleep parameters included insomnia severity, self-reported presleep arousal, and sleep quality; and polysomnographically-assessed sleep latency (SL), total sleep time (TST), wake after sleep onset (WASO), percent delta (stage 3 + 4 NREM), percent REM, and EEG beta power. Hierarchical linear regression was used to assess the relationship between distress from interpersonal problems and sleep and the extent to which relationships differed among insomnia patients and controls.

Results

More interpersonal distress was associated with more self-reported arousal and higher percentage of REM. More interpersonal distress was associated with greater insomnia severity and more cognitive presleep arousal for individuals with insomnia, but not for controls. Contrary to expectations, interpersonal distress was associated with shorter sleep latency in the insomnia group. Results were attenuated, but still significant, after adjusting for depression symptoms.

Conclusion

Distress from interpersonal problems is associated with greater self-reported arousal and higher percent REM. Individuals with insomnia who report more distress from interpersonal problems have greater insomnia severity and cognitive presleep arousal, perhaps due to rumination. These findings extend our knowledge of the association between interpersonal stressors and sleep. Assessment and consideration of interpersonal distress could provide a novel target for insomnia treatment.     

On Idealism and Soberness

It is highly likely that most of us who have founded a psychoanalytic institute or have been responsible for administering one have approached this responsibility with something that approximates idealistic hopes and dreams. As with most other significant commitments in life, however, one soon finds that perfection does not exist, and one begins to adjust to aims and goals that fall short of the original ideals. Even within the most successful and well-respected institutions administrators must recognize the necessity for adaptive compromise.