Becoming an eCoach: Training therapists in online cognitive-behavioral therapy for chronic pain

Objective

Online cognitive-behavioral therapy (iCBT) is effective in supporting patients’ self-management. Since iCBT differs from face-to-face CBT on several levels, proper training of therapists is essential. This paper describes the development and evaluation of a therapist training based on theoretical domains that are known to influence implementation behavior, for an iCBT for chronic pain.

Feasibility of accelerometer technology with individuals with autism spectrum disorder referred for aggression,disruption, and self injury

BackgroundMost research on aggression, self-injury, and disruption in autism spectrum disorder (ASD) has relied on caregiver report or direct observation, both of which have limitations. Past studies demonstrate preliminary evidence for direct detection of these behaviors using accelerometers, but additional research is needed to determine the feasibility during actual clinical assessments and times when a therapist cannot be present for direct observation, as measurement during these periods has the most applied significance.AimsThis study addressed these gaps by evaluating the feasibility of accelerometer use with children with ASD and severe aggression, self-injury, and disruption in clinical and home contexts.Methods and ProceduresWe evaluated the feasibility of individuals with ASD wearing accelerometers during behavioral assessments following structured habituation procedures. We also evaluated the feasibility of caregivers applying sensors to individuals with ASD in the home setting.Outcomes and ResultsMost participants passed habituation and tolerated sensors during behavioral assessments (e.g., functional analyses). Caregivers applied sensors in the home with variable fidelity with wear time duration and data-collection.Conclusions and ImplicationsThe feasibility of using accelerometers with this population is promising and should be explored further in future research.     

药学技术信息服务模式的实践和思考

目的：探讨药学服务模式转型中药学技术信息服务的切入点和方法。方法：通过我院药师在药学技术信息服务中的具体做法及取得的效果,进行分析思考。结果：在药品不良反应监测与报告、不合理处方干预、处方点评、临床药师制、合理用药宣传、用药咨询等方面,药师对安全、合理用药可发挥积极作用。结论：药师要有紧迫感和责任感,以“合理用药、安全用药、对药疗结果承担相应责任”为目标,主动投身并开展多种形式的药学技术信息服务,自觉成为医、药、护医疗团队中一员。     

Time series analysis of use patterns for common invasive technologies in critically ill patients

Purpose

Critically ill patients are frequently managed with invasive technologies as part of their medical care. Little is known about use patterns. We examined use trends for invasive technologies used in critically ill patients.

Materials and Methods

Using time series analysis and data on 26?989 patients from 3 medical-surgical intensive care units (ICUs) (n = 18?224) and 1 surgical ICU (n = 8765) between January 1, 1999, and January 1, 2007, we measured changes in the proportion of patients receiving the 4 most frequently used invasive technologies used in critically ill patients.

Results

The 4 most common invasive technologies used in critically ill patients during the study period were arterial lines (71%), endotracheal intubations (61%), central venous catheters (51%), and pulmonary artery catheters (18%). The proportion of ICU patients who received pulmonary artery catheters decreased from 25% in 1999 to 8% in 2006 (P < .001). Use of central venous catheters increased from 39% to 46% (P < .001). After adjusting for baseline characteristics, patients admitted in 2006 were 4 times less likely to receive a pulmonary artery catheter (odds ratio, 0.28; 95% confidence interval, 0.24-0.33), but 42% (odds ratio, 1.42; 95% confidence interval, 1.27-1.58) more likely to receive a central venous catheter than patients admitted in 1999. No significant changes were observed for intubations and arterial lines.

Conclusions

The use of invasive technologies in critically ill patients is changing and may have important implications for resource use, clinician education, and patient care. Initiatives should be considered for ensuring clinician competency during technology transitions.     

Validation of the Spinal Cord Injury–Functional Index for Use in Community-Dwelling Individuals With SCI

ObjectiveTo evaluate the psychometric properties of the Spinal Cord Injury–Functional Index (SCI-FI) instruments in a community-dwelling sample.DesignCross-sectional study.SettingCommunity setting.ParticipantsIndividuals (N=269) recruited from 6 SCI Model Systems sites.InterventionsNot applicable.Main Outcome MeasuresParticipants completed computer adaptive test and short form versions of 4 SCI-FI/Capacity (C) banks (ie, Ambulation, Basic Mobility, Fine Motor, Self-Care) and 1 SCI-FI/Assistive Technology (AT) bank (Wheelchair Mobility) at baseline and after 2 weeks. The Self-Report Functional Measure (SRFM) and the clinician-rated motor FIM were used to evaluate evidence of convergent validity.ResultsPearson correlations, intraclass correlation coefficients, minimal detectable change, and Bland-Altman plots supported the test-retest reliability of the SCI-FI instruments. Correlations were large with the SRFM (.69-.89) and moderate-to-large for the FIM instrument (.44-.64), supporting convergent validity. Known-groups validity was demonstrated by a significant main effect of injury level on all instruments and a main effect of injury completeness on the SCI-FI/C instruments. A ceiling effect was detected for individuals with incomplete paraplegia on the Fine Motor/C and Self-Care/C Short Forms.ConclusionFindings support the test-retest reliability, convergent validity, and known-groups validity of the SCI-FI/C instruments and the SCI-FI/AT Wheelchair Mobility instruments for use by community-dwelling individuals.