Hypnosis as an empirically supported clinical intervention: the state of the evidence and a look to the future

Drawing on the literature reviews of this special issue of the International Journal of Clinical and Experimental Hypnosis (2000), this article summarizes the evidence for the effectiveness of hypnosis as an empirically supported clinical intervention. As a whole, the clinical research to date generally substantiates the claim that hypnotic procedures can ameliorate some psychological and medical conditions, as judged against the Chambless and Hollon methodological guidelines. In many cases, these clinical procedures can also be quite cost-effective. It is probable that with some key empirical refinement a number of other hypnosis treatment protocols will have sufficient empirical documentation to be considered "well-established." However, it is noted that the Chambless and Hollon guidelines are not particularly well-suited for assessing hypnosis' impact when used adjunctly with other interventions. The article concludes with recommendations regarding the efficacy questions that need to be more fully addressed empirically and offers methodological guidelines for researchers and practitioners.     

A review of the common principles approach to integration of psychotherapies

Goldfried (1980) recommended that a consensual approach to psychotherapy be based on principles of change that cut across existing therapeutic systems. This paper reviews the common principles approach and suggests that commonalities identified so far represent neither meaningful consensus nor adequate guidelines for research. Instead of researching common principles to obtain consensus, we might do well to conduct therapy research within existing orientations but with flexibility in regard to what techniques are studied.Preparation of this article was facilitated by a University of Southern California Graduate School Fellowship,. I am grateful to W. Edward Craighead, Steven D. Hollon, anonymous reviewers, and especially Gerald C. Davison for comments on earlier versions of this article.     

Results of a worldwide survey on the assessment of platelet function by light transmission aggregometry: a report from the platelet physiology subcommittee of the SSC of the ISTH

Background: Light transmission aggregometry (LTA) is the most common method used in clinical and research laboratories to assess platelet function. However, the method has never been standardized. Objectives: As the first step towards development of methodological guidelines, the Platelet Physiology Subcommittee of the Scientific and Standardization Committee of the International Society on Thrombosis and Haemostasis (ISTH) undertook a large, detailed, global survey of LTA practices. Methods: Members of ISTH and of External Quality Assurance in Thrombosis and Haemostasis organizations were invited to complete a 129 item, online questionnaire. Results were analyzed anonymously to participant identities. Results: The online supplement for this article ( http://www.isth.org/Publications/OfficialCommunications/PlateletPhysiology/LightTransmissionAggregometry/tabid/201/Default.aspx ) contains the full details of the study findings. 359 (244 clinical, 115 research) laboratories from 48 countries participated in the survey. LTA was widely used to assess inherited or acquired bleeding disorders. Common practices were identified in sample collection, processing and analysis and although some are generally considered acceptable, others are not ideal. The agonist concentrations used for LTA varied, and many laboratories used ADP, collagen, epinephrine and Ristocetin, at more than one concentration, in addition to arachidonic acid. The parameters commonly used to assess LTA responses were maximal amplitude or % aggregation, which was considered particularly important, in addition to the presence of a ‘secondary wave’, deaggregation, shape change and a measure of the lag phase. However, many laboratories did not have appropriate reference intervals. Conclusions: This is the largest and most detailed survey of LTA practices ever undertaken. It shows a very high variability in LTA practices worldwide, and, as a consequence, methodological standardization is necessary. The information gathered in this survey will be helpful in the development of ISTH methodological guidelines for LTA.     

A Review of CAM for Procedural Pain in Infancy: Part I. Sucrose and Non-nutritive Sucking

There is increasing concern regarding the number of painful medical procedures that infants must undergo and the potential risks of alleviating infant pain with conventional pharmacologic agents. This article is Part I of a two-part series that aims to provide an overview of the literature on complementary and alternative (CAM) approaches for pain and distress related to medical procedures among infants up to six weeks of age. The focus of this article is a review of the empirical literature on sucrose with or without non-nutritive sucking (NNS) for procedural pain in infancy. Computerized databases were searched for relevant studies including prior reviews and primary trials. The most robust evidence was found for the analgesic effects of sucrose with or without NNS on minor procedural pain in healthy full-term infants. Despite some methodological weaknesses, the literature to date supports the use of sucrose, NNS and other sweetened solutions for the management of procedural pain in infancy.     

Developing the general principles of psychological skills in mental health nursing

The world's older population is expected to show a three-fold increase in the next 50 years. In 2000, older people in the UK accounted for nearly one-sixth of the population. As people live longer, pressure on services to deliver interventions that meet the psychological as well as the physical needs of older people will increase (Laidlaw 2004). In the past 20 years, cognitive behavioural therapy has become an increasingly popular approach to a wide range of mental health problems (Hollon 1998) and evidence of its efficacy has grown remarkably (Sourial 1997; Hollon et al 1993; Laidlaw 2004). This article shows that older people can and do benefit from CBT provided by clinical nurse specialists. It also argues that providing opportunities for mental health staff to increase their understanding of CBT is another important function of the specialist nurse's role.     

Illustration of a three-step process for identifying the level and quality of empirical support for manualized treatments

This article illustrates a three-step process for identifying the level and quality of empirical support available for treatments for persons with communication disorders. This appraisal process is illustrated for a well-established manualized treatment (MT) used to treat children with autism, namely Lovaas and colleagues’ The Me Book (1981). The process involved a series of three steps, each of which is carefully described and illustrated: (a) conducting the search and selection for research articles relevant to the MT, (b) studying the corpus of articles for methodological quality, and (c) classifying the MT for its level of empirical support. The results of this three-step process identified this MT as having adequate empirical support to classify it as effective. The limitation of appraising only published peer-reviewed research was noted with respect to the possibility of publication bias. The process illustrated in this article may be applied to other treatments to improve the evidence-based practices of clinicians who serve individuals with communication disorders.     

Subtle coercion in psychiatric practice

Making nursing decision for patients who cannot communicate their own wishes and needs is a common problem in psychiatric and mental health nursing. The aim of this article is to present the findings of a qualitative study focused on situations in which patients do not cooperate with a nursing decision about what should be done for them. The design of the study utilized some steps associated with the grounded theory method. Data were collected from unstructured interviews with 10 British nurses with long experience in psychiatric nursing. By implementing the strategy of constant comparative analysis of the transcribed interviews, it was found that nurses use different types of subtle coercion in order to achieve their own goals for the patient. These goals were justified as being in the best interest of the patient. The main components of subtle coercion are part of a process consisting of: assessing a patient's competency for self-choice; acting strategically; modifying the principle of autonomy; justifying strategies; and reflecting ethically on the actions taken. The study indicates that further empirical investigation of clinical situations involving subtle coercion is required. Particular attention should be paid to organizational factors and how these contribute to the use of subtle coercion. A specific question that needs to be theoretically and empirically explored is, can coercion be justified as ‘ethically right’ in some situations but not in others?     

Calidad de las guías de práctica clínica sobre úlceras venosas de la extremidad inferior

The clinical variability and professional uncertainty in the prevention and treatment of lower extremity venous ulcers (VU) has as a main consequence, the fact that patients can be subjected to diagnostic and therapeutic tests, sometimes of dubious utility, these may even be harmful to the health of the patient and that, at other times, certain procedures or processes that may be appropriate to the patient's situation and needs may be omitted.It is for this reason that a series of specific documents called clinical practice guidelines for the approach of VU (CPG-VU) have been created, with the aim of improving the effectiveness and quality of care, reducing unjustified variability and establishing homogeneous criteria for its handling. Nevertheless, the literature shows that not all CPGs have the same methodological and evidence-drawing criteria. Many of them are of poor scientific quality and editorial rigor. This implies that CPGs should be periodically reviewed and updated based on the most current evidence and their quality contrasted with validated instruments such as AGREE-II.After an analysis of the quality of six CPG-VU available today, it has been possible to identify what guidelines are recommended for its implementation in the practice of care, which should be modified to improve their applicability and development of the evidence.     

Those Who Think They Look Worst Respond Best: Self-observer Discrepancy Predicts Response to Video Feedback Following a Speech Task

Recent evidence suggests that video feedback helps improve the accuracy of self-ratings of performance in speech-anxious participants (e.g., Rapee & Hayman, 1996. Behaviour Research and Therapy, 34, 315–322.). Evidence also suggests that this effect is stronger for participants who have a more negatively distorted impression of their performance (self-observer discrepancy; Rodebaugh & Chambless, 2002. Cognitive Therapy and Research, 26, 629–644.). Data collected in Rapee and Hayman’s study were analyzed to determine if similar results would be found in this independent sample. Evidence was found for moderating effects of self-observer discrepancy comparable to those shown in Rodebaugh and Chambless. The self-observer discrepancy itself showed relatively weak relationships with general indices of social anxiety, but a very strong relationship with initial self-rating of performance. The results suggest that self-observer discrepancy is a predictor of response to video feedback, and that clinicians may be able to estimate the discrepancy by examining self-rating in conjunction with behavior.     

Methodological challenges during 20 years of adolescent research

The purpose of the present article was to highlight the methodological challenges we have experienced in conducting adolescent research for the past 20 years or more. In this article, we describe the methodological issues we have encountered with nonexperimental research designs, sampling, instrumentation, data collection procedures, statistical analyses, and ethical concerns of adolescent research, particularly the process of informed consent. Sharing our experiences with adolescent research can shed light on methodological issues (specifically in this age group) that are not addressed in research textbooks and can provide guidance for other researchers who are interested in developing knowledge relevant to adolescent populations.     

从知到行:跨越指南理论与实践的鸿沟

随着循证医学和临床实践指南的快速发展以及转化医学与实施科学的兴起,加强证据的转化与利用,促进高质量指南的传播与实施,已在国内外学者中引起广泛关注。本文对当前指南传播与实施的现状、基本步骤、阻碍与促进因素进行分析和总结,对其与实施科学之间的关系展开论述,并在此基础上就我国如何提升指南传播与实施效果提出思考和建议。     

医疗大数据时代下的Meta分析

循证医学在大数据时代迎来了绝佳的发展机遇。Meta分析作为循证医学的高级别证据,其写作方法应为临床医师熟练掌握。完成一篇高质量的Meta分析需要全面了解其方法流程,根据研究的临床问题选择合适的分析类型,从构建临床问题到数据分析撰写,皆需遵循国际通用的规范和指南要求。精准选题,严守规范,用心琢磨,方能为临床决策提供高级别的医学证据。     

Psychotherapy research: new findings and implications for training and practice.

The last decade has seen progress in psychotherapy research, despite the methodological complexity in this field. However, empirical research has influenced training and clinical practice to only a limited extent. This article is a brief evaluation of trends and some findings in modern psychotherapy research that may influence professional psychotherapy training and practice.     

A review of quality assessment of the methodology used in guidelines and systematic reviews on oral mucositis

Aims and objectives. The objective of this study was to identify and to assess the quality of evidence‐based guidelines and systematic reviews we used in the case of oral mucositis, to apply general quality criteria for the prevention and treatment of oral mucositis in patients receiving chemotherapy, radiotherapy or both. Design. Systematic review. Methods. Literature searches were carried out in several electronic databases and websites. Publications were included if they concerned oral mucositis involving adults treated for cancer and had been published after 1 January 2000. As far as systematic reviews were concerned, the article had to report a search strategy, if the search was minimally conducted in the database PubMed or Medline and the articles included in the review were subjected to some kind of methodological assessment. The Appraisal of Guidelines for Research and Education (AGREE) instrument was used to assess the quality of the guidelines and the Overview Quality Assessment Questionnaire (OQAQ) was used for the quality of systematic reviews. Results. Thirty‐one articles met the inclusion criteria of which 11 were guidelines and 20 were systematic reviews. Nine of the 11 guidelines did not explicitly describe how they identified, selected and summarised the available evidence. Reviews suffered from lack of clarity, for instance, in performing a thorough literature search. The quality varied among the different guidelines and reviews. Conclusion. Most guidelines and systematic reviews had serious methodological flaws. Relevance to clinical practice. There is a need to improve the methodological quality of guidelines and systematic reviews for the prevention and treatment of oral mucositis if they are to be used in clinical practice.     

GRADE方法在呼吸机相关性肺炎诊断、预防和治疗指南制定中的应用

本文介绍VAP循证临床实践指南制定方法和注意事项,探讨GRADE方法与其他临床指南方法学研究的异同点,重点分析文献检索、证据质量和推荐强度形成方法等内容,以及如何确保正确理解和合理使用GRADE方法的具体措施。利用GRADE方法来制定VAP循证临床实践指南,可以很清楚地呈现纳入证据的质量,并明确给出推荐意见。     

Theoretical model of coping among relatives of patients in intensive care units: a simultaneous concept analysis

This paper reports the development of a theoretical model of relatives' coping approaches during the patient's intensive care unit stay and subsequent recovery at home by performing an analysis of concepts generated from two empirically grounded, theoretical studies in this area. BACKGROUND: When supporting relatives of intensive care unit patients, it is important that nurses have access to evidence-based knowledge of relatives' coping approaches during the period of illness and recovery. METHOD: Simultaneous concept analysis was used to refine and combine multiple coping concepts into a theoretical model of coping. The concepts were generated in two previous empirical studies of relatives' coping approaches during mechanically ventilated patients' intensive care unit stays and recovery at home. FINDINGS: The theoretical model was developed in 2004-2005 and illustrates the effectiveness of different coping approaches in relation to each other and to social support. Definitions summarizing each coping approach and containing the knowledge gained through the simultaneous concept analysis method were also formulated. CONCLUSION: This middle-range theory of relatives' coping approaches may make a valuable contribution to international intensive care unit nursing practice, especially as it is based on empirical studies and may therefore serve as a basis for the development of future clinical guidelines. However, the theoretical model needs to be empirically validated before it can be used.     

临床实践指南如何“保鲜”

临床实践指南是医疗实践的指导性文件, 及时修订的指南推荐意见对于指导医生进行临床决策具有重要意义和价值。因此, 指南应基于最新的研究证据, 形成对当前医疗实践的最佳推荐意见, 并保持与时俱进。本文针对指南修订的现状、方法、流程及存在的问题展开讨论, 提出指南修订最长周期为5年, 最短可以做到实时更新; 修订方法目前国内外无统一标准, 建议可参考本文提出的流程及RIGHT和CheckUp报告清单。此外, 本文就如何有效开展修订工作, 从指南管理者、制订者、研究者和使用者四个层面提出思考与建议。     

Community-acquired pneumonia in adults.

The incidence and mortality rates of community-acquired pneumonia (CAP) continue to rise as patients age. The clinical presentation of CAP is variable; therefore, diagnosis can be challenging. Clinicians must rely on a careful history and physical examination when choosing empirical antibiotic treatment. Using current guidelines, this article discusses the pathogenesis, clinical presentation, differential diagnosis, prognosis, and treatment of adults with CAP in the primary care setting.